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Prevalence of Pre-pregnancy Obesity, 2011-2014
Abstract
Importance:
Obesity before and during pregnancy increases risk among mothers for poor health outcomes, such as diabetes, high blood pressure, and cardiovascular disease.
Objective:
To describe trends in pre-pregnancy obesity rates among women in Wisconsin.
Methods:
Cross-sectional data from Wisconsin birth certificates were analyzed. Prevalence of pre-pregnancy obesity (defined as body mass index = 30) among Wisconsin women who gave birth from 2011 through 2014 was compared across demographic and geographic dimensions.
Results:
Overall, 27.8% of Wisconsin women who gave birth during 2011-2014 were obese. Obesity rates were highest among 40- to 44-year-old women (31.8%), women with a high school/GED diploma (32.8 %), American Indian/Alaska Native women (43.9%), and women with 5 or more pregnancies (35.4%). Obesity rates varied by county of residence (highest in Forest County, 45.2%) and city of residence (highest in the city of Racine, 34.8%).
Conclusions:
There are significant socioeconomic, racial, and geographic disparities in pre-pregnancy obesity among women who give birth in Wisconsin.
... The pre-pregnancy obesity was increasingly prevalent in women of different ages or races (Angarita et al., 2022;Dixit & Girling, 2008;Kim et al., 2007). Obese women whose pre-pregnancy body mass index (BMI) >30 kg/m 2 are considered to enter pregnancy with more risk (Guo et al., 2021;Vitner et al., 2019), such as the performance of caesarean delivery (Crane et al., 1997;Gregor et al., 2016;Vahratian et al., 2005). Previous research has found a link between obese women who had a caesarean section and an increased likelihood of surgical site infection (SSI) Shrestha et al., 2014), which leads to the prolonged hospital stay, additional surgical procedures and increased mortality (Donowitz & Wenzel, 1980;Heslehurst et al., 2008). ...
Aims:
The purpose of this study is to assess the efficacy of prophylactic negative pressure wound therapy (NPWT) in obese women undergoing caesarean section.
Design:
An updated review and meta-analysis of randomized controlled trials following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Methods:
PubMed, Embase, Medline, Web of Science, and Cochrane Library were searched from inception up to March 2022 without restriction in language. We chose surgical site infection as the primary outcome.
Results:
NPWT resulted in a lower surgical site infection rate compared with conventional dressing (risk ratio [RR] = 0.76). The infection rate after low transverse incision was lower comparing the NPWT group with the control group ([RR] = 0.76). No statistically significant difference was detected in blistering([RR] = 2.91). The trial sequential analysis did not support the 20% relative decrease in surgical site infection in the NPWT group. (type II error of 20%).
... Maternal overweight and obesity is another major concern as 17.82%-27.8% of women are obesity before conception in different countries. [4][5][6] Preconception obesity usually predisposes the offspring to an array of developmental disorders, physically and mentally. Prepregnancy obesity has been shown to be involved in a variety of severe pregnancy complications, such as gestational diabetes, preeclampsia, postpartum hemorrhage, and thromboembolism. ...
Objective: Increasing evidences have shown that prepregnancy maternal weight and gestational weight gain (GWG) may associate with offspring's neurodevelopment. However, the effects of prepregnancy maternal overweight, obesity, and excessive GWG on offspring's intelligence remain controversial. This meta-analysis aimed to re-assess the association between prepregnancy body mass index (BMI), GWG, and children's intelligence.
Methods: We systematically searched multiple databases, including PubMed, EMBASE, Cochrane Library, and Ovid Medline, from their inception through February 2021. Studies assessing the association between prepregnancy BMI or GWG and children's intelligence were further screened manually before final inclusion. Cohorts that analyzed the association between prepregnancy BMI or GWG and intelligence of offspring were included, and we used the Mantel–Haenszel fixed-effects method to compute the weighted mean difference (WMD) and 95% confidence interval (CI) of each study.
Results:A total of 12 articles were included in this systematic review, while six of them in the meta-analysis. There was a significant full-scale IQ reduction in children born from overweight and obese mothers, with WMDs of −3.08 (95% CI: −4.02, −2.14) and −4.91 (95% CI: −6.40, −3.42), respectively. Compared with control group, the WMDs for performance and verbal intelligence quotient (IQ) were decreased in overweight and obesity groups. However, we observed no association between children's full-scale IQ and excessive GWG with WMD of −0.14 (95% CI: −0.92, 0.65).
Conclusions: Women's prepregnancy overweight and obesity adversely associate with children's intelligence but no association with excessive GWG. Our study suggests that further researches focusing on the effect of prepregnancy maternal health on offspring's intelligence development are needed.
... Maternal overweight and obesity is another major concern as 17.82%-27.8% of women are obesity before conception in different countries. [4][5][6] Preconception obesity usually predisposes the offspring to an array of developmental disorders, physically and mentally. Prepregnancy obesity has been shown to be involved in a variety of severe pregnancy complications, such as gestational diabetes, preeclampsia, postpartum hemorrhage, and thromboembolism. ...
Objective: Increasing evidences have shown that prepregnancy maternal weight and gestational weight gain (GWG) may associate with offspring's neurodevelopment. However, the effects of prepregnancy maternal overweight, obesity, and excessive GWG on offspring's intelligence remain controversial. This meta-analysis aimed to re-assess the association between prepregnancy body mass index (BMI), GWG, and children's intelligence.
Methods: We systematically searched multiple databases, including PubMed, EMBASE, Cochrane Library, and Ovid Medline, from their inception through February 2021. Studies assessing the association between prepregnancy BMI or GWG and children's intelligence were further screened manually before final inclusion. Cohorts that analyzed the association between prepregnancy BMI or GWG and intelligence of offspring were included, and we used the Mantel–Haenszel fixed-effects method to compute the weighted mean difference (WMD) and 95% confidence interval (CI) of each study.
Results:A total of 12 articles were included in this systematic review, while six of them in the meta-analysis. There was a significant full-scale IQ reduction in children born from overweight and obese mothers, with WMDs of −3.08 (95% CI: −4.02, −2.14) and −4.91 (95% CI: −6.40, −3.42), respectively. Compared with control group, the WMDs for performance and verbal intelligence quotient (IQ) were decreased in overweight and obesity groups. However, we observed no association between children's full-scale IQ and excessive GWG with WMD of −0.14 (95% CI: −0.92, 0.65).
Conclusions: Women's prepregnancy overweight and obesity adversely associate with children's intelligence but no association with excessive GWG. Our study suggests that further researches focusing on the effect of prepregnancy maternal health on offspring's intelligence development are needed.
... These conditions are associated with higher cardiovascular disease risk and mortality. A particular concern emerged in the past two decades, namely obesity during pregnancy (Heslehurst et al., 2010;Huda et al., 2010;Gregor et al., 2016;Lindberg et al., 2016;Kominiarek and Peaceman, 2017). Nearly two thirds of women of childbearing age are overweight and 36.5% are obese. ...
Obesity has long been identified as a global epidemic with major health implications such as diabetes and cardiovascular disease. Maternal overnutrition leads to significant health issues in industrial countries and is one of the risk factors for the development of obesity and related disorders in the progeny. The wide accessibility of junk food in recent years is one of the major causes of obesity, as it is low in nutrient content and usually high in salt, sugar, fat, and calories. An excess of nutrients during fetal life not only has immediate effects on the fetus, including increased growth and fat deposition in utero, but also has long-term health consequences. Based on human studies, it is difficult to discern between genetic and environmental contributions to the risk of disease in future generations. Consequently, animal models are essential for studying the impact of maternal overnutrition on the developing offspring. Recently, animal models provided some insight into the physiological mechanisms that underlie developmental programming. Most of the studies employed thus far have focused only on obesity and metabolic dysfunctions in the offspring. These studies have advanced our understanding of how maternal overnutrition in the form of high-fat diet exposure can lead to an increased risk of obesity in the offspring, but many questions remain open. How maternal overnutrition may increase the risk of developing brain pathology such as cognitive disabilities in the offspring and increase the risk to develop metabolic disorders later in life? Further, does maternal overnutrition exacerbate cognitive- and cardio-metabolic aging in the offspring?
... Global obesity of women aged 20 years and older is currently estimated to be around 30%, with prevalence close to or over 60% in some countries (Ng et al., 2014). Rates of maternal obesity are also on the rise (Kim et al., 2007;Heslehurst et al., 2010;Gregor et al., 2016), due to both greater numbers of obese pregnant women and excess weight gain during pregnancy (Siega-Riz and Gray, 2013;Lindberg et al., 2016). ...
Compelling experimental and clinical evidence supports a role for maternal obesity in offspring health. Adult children of obese mothers are at greater risk of obesity, diabetes, coronary heart disease and stroke. These offspring may also be at greater risk of age-related neurodegenerative diseases for which mid-life obesity is a risk factor. Rodent diet-induced obesity models have shown that high fat (HF) diet consumption damages the integrity of the blood–brain barrier (BBB) in the adult brain. However, there is currently little information about the effect of chronic HF feeding on the BBB of aged animals. Moreover, the long-term consequences of maternal obesity on the cerebrovasculature of aged offspring are not known. This study determined the impact of pre- and post-natal HF diet on the structure and integrity of cerebral blood vessels in aged male and female mice. Female C57Bl/6 mice were fed either a 10% fat control (C) or 45% HF diet before mating and during gestation and lactation. At weaning, male and female offspring were fed the C or HF diet until sacrifice at 16-months of age. Both dams and offspring fed the HF diet weighed significantly more than mice fed the C diet. Post-natal HF diet exposure increased hippocampal BBB leakiness in female offspring, in association with loss of astrocyte endfoot coverage of arteries. Markers of tight junctions, pericytes or smooth muscle cells were not altered by pre- or post-natal HF diet. Male offspring born to HF-fed mothers showed decreased parenchymal GFAP expression compared to offspring of mothers fed C diet, while microglial and macrophage markers were higher in the same female diet group. In addition, female offspring exposed to the HF diet for their entire lifespan showed more significant changes in vessel structure, BBB permeability and inflammation compared to male animals. These results suggest that the long-term impact of prenatal HF diet on the integrity of cerebral blood vessels differs between male and female offspring depending on the post-natal diet. This may have implications for the prevention and management of age- and obesity-related cerebrovascular diseases that differentially affect men and women.
... 3 The health risks associated with unhealthy weight gain during pregnancy are in addition to the risks posed by pre-pregnancy weight status, which are detailed elsewhere. 4,5 The current Institute of Medicine (IOM) guidelines attempt to balance the competing risks of insufficient versus excess weight gain during pregnancy and are tailored to reflect the different metabolic needs and risk profiles of women based on pre-pregnancy body mass index (BMI) and fetal number. 3 Fewer than half of pregnant women in the United States currently achieve a healthy gestational weight gain within IOM recommendations. ...
Importance:
Weight gain during pregnancy affects obesity risk in offspring.
Objective:
To assess weight gain among UW Health prenatal patients and to identify predictors of unhealthy gestational weight gain.
Methods:
Retrospective cohort study of women delivering at UW Health during 2007-2012. Data are from the UW eHealth Public Health Information Exchange (PHINEX) project. The proportion of women with excess and insufficient (ie, unhealthy) gestational weight gain was computed based on 2009 Institute of Medicine guidelines. Multivariable logistic regression was used to identify risk factors associated with excess and insufficient gestational weight gain.
Results:
Gestational weight gain of 7,385 women was analyzed. Fewer than 30% of prenatal patients gained weight in accordance with Institute of Medicine guidelines. Over 50% of women gained excess weight and 20% gained insufficient weight during pregnancy. Pre-pregnancy weight and smoking status predicted excess weight gain. Maternal age, race/ethnicity, smoking status, and having Medicaid insurance predicted insufficient weight gain.
Conclusions and relevance:
Unhealthy weight gain during pregnancy is the norm for Wisconsin women. Clinical and community interventions that promote healthy weight gain during pregnancy will not only improve the health of mothers, but also will reduce the risk of obesity in the next generation.
... Figure 1 illustrates the multiple components of the surveillance system which includes data for the state as a whole, 1,23 as well as for specific subpopulations and geographic regions. 24 In addition to developing the surveillance system, this core is working to develop shared metrics and is evaluating healthTIDE and community intervention outcomes (Figure 1). UW-Madison faculty with expertise in community research, evaluation, and obesity prevention are assisting in the strategy selection process and are working with communities to set up evaluation indicators with specific reporting indicators at pre-, midpoint, and post-3 years of intervention work, and beyond. ...
Background/significance:
Obesity rates have increased dramatically, especially among children and disadvantaged populations. Obesity is a complex issue, creating a compelling need for prevention efforts in communities to move from single isolated programs to comprehensive multisystem interventions. To address these issues, we have established a childhood Obesity Prevention Initiative (Initiative) for Wisconsin. This Initiative seeks to test community change frameworks that can support multisystem interventions and provide data for local action as a means for influencing policies, systems, and environments that support individuals' healthy eating and physical activity.
Approaches/aims:
The Initiative is comprised of three components: (1) infrastructure to support a statewide obesity prevention and health promotion network with state- and local-level public messaging and dissemination of evidence-based solutions (healthTIDE); (2) piloting a local, multisetting community-led intervention study in 2 Wisconsin counties; and (3) developing a geocoded statewide childhood obesity and fitness surveillance system.
Relevance:
This Initiative is using a new model that involves both coalition action and community organizing to align resources to achieve health improvement at local and state levels. We expect that it will help lead to the implementation of cohesive and sustainable policy, system, and environment health promotion and obesity prevention strategies in communities statewide, and it has the potential to help Wisconsin become a national model for multisetting community interventions to address obesity. Addressing individual-level health through population-level changes ultimately will result in reductions in the prevalence of childhood obesity, current and future health care costs, and chronic disease mortality.
... Epidemiologic studies provide evidence that obesity and its complications are increasingly rising in western countries (Flegal et al., 2012;Ng et al., 2014), and with it, the rates of obesity during pregnancy (Kim et al., 2007;Heslehurst et al., 2010;Gregor et al., 2016). ...
Pre- and post-natal factors can affect brain development and function, impacting health outcomes with particular relevance to neurodevelopmental diseases, such as autism spectrum disorders (ASDs). Maternal obesity and its associated complications have been related to the increased risk of ASDs in offspring. Indeed, animals exposed to maternal obesity or high fat diets are prone to social communication impairment and repetitive behavior, the hallmarks of autism. During development, fatty acids and sugars, as well as satiety hormones, like insulin and leptin, and inflammatory factors related to obesity-induced low grade inflammation, could play a role in the impairment of neuroendocrine system and brain neuronal circuits regulating behavior in offspring. On the other side, post-natal factors, such as mode of delivery, stress, diet, or antibiotic treatment are associated to a modification of gut microbiota composition, perturbing microbiota-gut-brain axis. Indeed, the interplay between the gastrointestinal tract and the central nervous system not only occurs through neural, hormonal, and immune pathways, but also through microbe-derived metabolic products. The modification of unhealthy perinatal and postnatal environment, manipulation of gut microbiota, nutritional, and dietary interventions could represent possible strategies in preventing or limiting ASDs, through targeting inflammatory process and gut microbiota.
... In some countries, such as Kuwait, Libya, and Tonga, the estimated prevalence of obesity among women aged 20 years and older is close to or over 60% [1]. Rates of maternal obesity have risen in parallel [2][3][4], due to both greater numbers of obese pregnant women and excess weight gain during pregnancy [5,6]. ...
Globally, more than 20% of women of reproductive age are currently estimated to be obese. Children born to obese mothers are at higher risk of developing obesity, coronary heart disease, diabetes, stroke, and asthma in adulthood. Increasing clinical and experimental evidence suggests that maternal obesity also affects the health and function of the offspring brain across the lifespan. This review summarizes the current findings from human and animal studies that detail the impact of maternal obesity on aspects of learning, memory, motivation, affective disorders, attention-deficit hyperactivity disorder, autism spectrum disorders, and neurodegeneration in the offspring. Epigenetic mechanisms that may contribute to this mother–child interaction are also discussed.
... Figure 1 illustrates the multiple components of the surveillance system which includes data for the state as a whole, 1,23 as well as for specific subpopulations and geographic regions. 24 In addition to developing the surveillance system, this core is working to develop shared metrics and is evaluating healthTIDE and community intervention outcomes (Figure 1). ...
Background/Significance: Obesity rates have increased dramatically, especially among children and
disadvantaged populations. Obesity is a complex issue, creating a compelling need for prevention
efforts in communities to move from single isolated programs to comprehensive multisystem interventions.
To address these issues, we have established a childhood Obesity Prevention Initiative (Initiative)
for Wisconsin. This Initiative seeks to test community change frameworks that can support multisystem
interventions and provide data for local action as a means for influencing policies, systems, and environments
that support individuals’ healthy eating and physical activity.
Approaches/Aims: The Initiative is comprised of three components: (1) infrastructure to support a statewide
obesity prevention and health promotion network with state- and local-level public messaging and
dissemination of evidence-based solutions (healthTIDE); (2) piloting a local, multisetting community-led
intervention study in 2 Wisconsin counties; and (3) developing a geocoded statewide childhood obesity
and fitness surveillance system.
Relevance: This Initiative is using a new model that involves both coalition action and community
organizing to align resources to achieve health improvement at local and state levels. We expect that
it will help lead to the implementation of cohesive and sustainable policy, system, and environment
health promotion and obesity prevention strategies in communities statewide, and it has the potential
to help Wisconsin become a national model for multisetting community interventions to address obesity.
Addressing individual-level health through population-level changes ultimately will result in reductions in
the prevalence of childhood obesity, current and future health care costs, and chronic disease mortality.
Alterations in neural pathways that regulate appetitive motivation may contribute to increased obesity risk in offspring born to mothers fed a high fat (HF) diet. However, current findings on the impact of maternal obesity on motivation in offspring are inconclusive, and there is no information about the long-lasting effects in aged animals. This study examined the longitudinal effect of perinatal and chronic postnatal HF intake on appetitive motivation in young and aged offspring. Female C57Bl/6 were fed either a control (C) or HF diet before mating through to lactation. At weaning, offspring were maintained on the C or HF diet, generating the following four diet groups: C/C, C/HF, HF/C, and HF/HF based on the pre/post weaning diet. At 6 months, motivation was higher in HF/C females, but lower in male and female C/HF and HF/HF mice. By 12 months, this difference was lost, as C-fed animals became less motivated, while motivation increased in HF-fed mice. The mRNA levels of dopamine receptor 1 and 2 increased with age, while cannabinoid receptor 1 and μ-opioid receptor expression remained stable or decreased in mesolimbic and mesocortical dopaminergic pathways. Results from this study suggest that perinatal and chronic postnatal HF feeding produced opposite effects on appetitive motivation in young adult offspring mice, which was also reflected in the shift in motivation over time. These results have significant implications for patterns of hedonic eating across the life course and the relative risk of obesity at different time points.
Background
Stigma and bias experienced during prenatal care can affect quality of care and, ultimately, the health of pregnant women with obesity and their infants. We sought to 1) better understand the bias and stigma that women with BMIs ≥40 kg/m² experience while receiving prenatal care, 2) gauge women’s interest in group prenatal education for women with obesity, and 3) gather feedback about their preferred weight-related terminology.
Methods
We conducted and thematically content-analyzed 30 semi-structured interviews of women with BMIs ≥40 kg/m² who received prenatal care at a university-affiliated teaching hospital in the Midwest region of the United States.
Results
All women recalled positive experiences during their perinatal care during which they felt listened to and respected by providers. However, many also described a fear of weight-related bias or recalled weight-based discrimination. Women reacted favorably to a proposed group prenatal care option for pregnant women with obesity that focused on nutrition, physical activity, and weight management. Women rated “weight” and “BMI” as the most desirable terms for describing weight, while “large size” and “obesity” were rated least desirable.
Conclusions
Many pregnant women with BMIs ≥40 kg/m² experience bias in the prenatal care setting. Potential steps to mitigate bias towards weight include improving provider awareness of the experiences and perspectives of this population, expanding prenatal care options targeted towards women with high BMIs, including group care, and using patient-preferred weight-related terminology. Through the remainder of this manuscript, wherever possible, the term “high BMI” will be used in place of the term “obesity” to describe women with BMI ≥ 30 kg/m² in order to respect the preferred terminology of the women we interviewed.
Infants of diabetic mothers are at risk of cardiomyopathy at birth and myocardial infarction in adulthood, but prevention is hindered because mechanisms remain unknown. We previously showed that maternal glucolipotoxicity increases the risk of cardiomyopathy and mortality in newborn rats through fuel-mediated mitochondrial dysfunction. Here we demonstrate ongoing cardiometabolic consequences by cross-fostering and following echocardiography, cardiomyocyte bioenergetics, mitochondria-mediated turnover, and cell death following metabolic stress in aged adults. Like humans, cardiac function improves by weaning with no apparent differences in early adulthood but declines again in aged diabetes-exposed offspring. This is preceded by impaired oxidative phosphorylation, exaggerated age-related increase in mitochondrial number, and higher oxygen consumption. Prenatally exposed male cardiomyocytes have more mitolysosomes indicating high baseline turnover; when exposed to metabolic stress, mitophagy cannot increase and cardiomyocytes have faster mitochondrial membrane potential loss and mitochondria-mediated cell death. Details highlight age- and sex-specific roles of mitochondria in developmentally programmed adult heart disease.
The prevalence of obesity and diabetes has increased rapidly in the general population over the last few decades, meaning that a significant number of women of reproductive age are now classified as obese and/or suffering from diabetes. More and more women are also delaying childbearing until older ages. This shift in maternal phenotype is accompanied by an increase in adverse pregnancy and labour outcomes. This review will summarise our current understanding of how maternal age, obesity and diabetes affect myometrial contractility and how these changes impact clinical outcomes.
Aims:
Determining how obesity affects function in human myometrial arteries, to help understand why childbirth has poor outcomes in obese women.
Methods:
Myometrial arteries were studied from 84 biopsies. Contraction (vasopressin and U-46619) and relaxation (carbachol, bradykinin, SNAP) was assessed using wire myography. eNOS activity was assessed using L-NAME. Cholesterol was reduced using methyl-β-cyclodextrin to determine whether it altered responses. Differences in endothelial cell intracellular Ca2+ signalling were assessed using confocal microscopy.
Results:
The effects of BMI on relaxation were agonist specific and very marked; all vessels, irrespective of BMI, relaxed to bradykinin but 0% of vessels (0/13) from obese women relaxed to carbachol, compared to 59% (10/17) from normal weight women. Cholesterol-lowering drugs did not restore carbachol responses (n=6). All vessels, irrespective of BMI, relaxed when NO was directly released by SNAP (n=19). Inhibition of eNOS with L-NAME had a significant effect in normal but not overweight/obese vessels. Compared to bradykinin, a lower proportion of endothelial cells responded to carbachol and the amplitude of the calcium response was significantly less, in all vessels. Furthermore, a significantly lower proportion of endothelial cells responded to carbachol in the overweight/obese group compared to control. In contrast to relaxation, the effect of contractile agonists was unchanged with increasing BMI.
Conclusions:
The ability of human myometrial arteries to relax is significantly impaired with obesity, and our data suggest this is due to a deficit in endothelial calcium signalling. This inability to recover following compression during contractions, might contribute to poor labours in obese women. This article is protected by copyright. All rights reserved.
Background
Maternal obesity, excessive gestational weight gain and fetal macrosomia may affect the health of the mother and the newborn, and are associated with cesarean delivery. Pregnant women with a migration background have a higher risk of obesity but nevertheless a lower frequency of cesarean deliveries than women from the majority population. This study assesses which of these factors most influence the risk of a cesarean delivery and whether their prevalence can explain the lower cesarean rates in migrant women.
Methods
A total of 2256 migrant women and 2241 non-immigrant women subsequently delivering in three hospitals of Berlin/Germany participated. Multivariate logistic regression analysis was conducted to assess the effects of obesity, excessive gestational weight gain and macrosomia on cesarean delivery. Standardized coefficients (STB) were used to rank the predictors.
Results
Obesity was more frequent in immigrant than among non-immigrant women. The mean gestational weight gain was independent of migration status. The frequency of macrosomia increased with maternal weight. Obesity and excessive gestational weight gain were the most important predictors of cesarean besides older age; fetal macrosomia played a much smaller role. Despite similar distributions of the three risk factors, the frequency of cesarean deliveries was lower in migrant than in non-immigrant women.
Conclusion
The presence of obesity and/or excessive gestational weight gain is associated with an increased risk of a cesarean delivery; fetal macrosomia does not increase the risk when obesity and weight gain are considered. The distribution of these risk factors is similar in migrant and non-immigrant women, so they cannot explain the lower frequency of cesarean deliveries in migrant women.
Maternal obesity during pregnancy increases risk for neurodevelopmental disorders in offspring, although the underlying mechanisms remain unclear. Epigenetic deregulation associates with many neurodevelopmental disorders, and recent evidence indicates that maternal nutritional status can alter chromatin marks in the offspring brain. Thus, maternal obesity may disrupt epigenetic regulation of gene expression during offspring neurodevelopment. Using a C57BL/6 mouse model, we investigated whether maternal high fat diet (mHFD)-induced obesity alters the expression of genes previously implicated in the etiology of neurodevelopmental disorders within the Gestational Day 17.5 (GD 17.5) offspring hippocampus. We found significant two-fold upregulation of oxytocin receptor (Oxtr) mRNA in the hippocampus of male, but not female, GD 17.5 offspring from mHFD-induced obese dams (p < 0.05). To determine whether altered histone binding at the Oxtr gene promoter may underpin these transcriptional changes, we then performed chromatin immunoprecipitation (ChIP). Consistent with the Oxtr transcriptional changes, we observed increased binding of active histone mark H3K9Ac at the Oxtr transcriptional start site (TSS) in the hippocampus of mHFD male (p < 0.05), but not female, offspring. Together, these data indicate an increased vulnerability of male offspring to maternal obesity-induced changes in chromatin remodeling processes that regulate gene expression in the developing hippocampus, and contributes to our understanding of how early life nutrition affects the offspring brain epigenome.
Background:
Neuraxial block-related hypotension and maternal obesity contribute to uterine hypoperfusion and decreased umbilical arterial pH at cesarean delivery. Between the time of anesthesia placement and delivery, the fetus may be exposed to a hypoperfused uterine environment without surgeon awareness of fetal compromise.
Objective:
We sought to evaluate neonatal umbilical arterial pH according to predelivery time intervals at scheduled term cesarean.
Study design:
We performed a retrospective cohort study of cesarean deliveries between September 2014 and February 2017. Singleton gestations undergoing scheduled cesarean delivery under spinal anesthesia between 37 and 41 weeks with a reassuring preoperative nonstress test were included. Time intervals between operative room entry, spinal anesthesia placement, skin incision, uterine incision, and delivery were calculated. The primary outcome was umbilical arterial pH. Demographic data, maternal blood pressures, predelivery time intervals, and delivery outcomes were analyzed according to umbilical arterial pH intervals of <7.0, 7.01-7.10, 7.11-7.20, 7.21-7.30, and >7.30. Umbilical cord gas analytes and neonatal outcomes were analyzed by spinal to delivery time. Stepwise linear regression was performed to identify predictors of decreasing umbilical arterial pH. Receiver-operator characteristic curves were calculated for spinal to delivery time and umbilical arterial pH <7.0 and 7.1.
Results:
Among 527 included participants, median umbilical arterial pH was 7.27 [interquartile range, 7.23-7.29] and body mass index was 35 kg/m2 [interquartile range, 30-41]. Both maternal body mass index and hypotensive episodes increased with decreasing umbilical arterial pH (P <.001, P ≤ .02). All predelivery time intervals (operative room to delivery, spinal to skin, spinal to delivery, and uterine incision to delivery) increased as umbilical arterial pH interval decreased (P < .05 for all). In a stepwise linear regression, maternal body mass index, noncephalic presentation, spinal start to delivery interval, uterine incision to delivery interval, and maximum reduction in blood pressure from baseline were predictive of decreasing umbilical arterial pH after controlling for confounding variables (F [5,442] = 17.7, P = .0001], adjusted R2 of 0.157. When evaluated by spinal to delivery time, both umbilical arterial and venous pH and partial pressure of carbon dioxide decreased (P < .001 for all), but base deficit and neonatal outcomes were similar (P ≥ .7 for all). There were 2 cases of hypoxic-ischemic encephalopathy (0.38%). A receiver-operating characteristic curve demonstrated that a spinal start to delivery time greater than 27 minutes was associated with an umbilical arterial pH <7.1 (area under the curve, 0.74, 100% sensitivity, 21% specificity), and an interval greater than 30 minutes was associated with an umbilical arterial pH <7.0 (area under the curve, 0.80, 100% sensitivity, 33% specificity).
Conclusion:
Longer spinal-to-delivery and uterine incision-to-delivery time intervals were associated with decreasing umbilical arterial pH at scheduled term cesarean delivery. Efforts to minimize predelivery time following spinal placement could reduce the frequency of unanticipated neonatal acidemia.
Background:
Adequate physical activity and cardiorespiratory fitness aid in the prevention of type 2 diabetes mellitus and obesity. Large sociodemographic/economic disparities exist for these conditions, which develop over time beginning in childhood. This paper examines disparities in both activity and fitness levels among children and adolescents in Wisconsin.
Methods:
The Wisconsin Partnership for Childhood Fitness collected cardiorespiratory fitness and physical activity data on 3,798 6th grade students in 37 schools in fall 2011. Fitness data were collected via testing in physical education classes. Activity data were collected via self-report, 1-day activity logs administered during school. Using hierarchical linear models, disparities in fitness and physical activity by race/ethnicity and school-level characteristics were investigated.
Results:
Widespread race and ethnic disparities exist in aerobic fitness, as well as more limited disparities in physical activity levels. In addition, students from schools with higher overall socioeconomic status (SES) were more active and had higher fitness levels than those from schools with overall lower SES levels.
Conclusions:
Among Wisconsin adolescents, race/ethnicity and school-level SES contribute to significant differences in both fitness and physical activity levels. Modifiable elements of the school environment to increase physical activity, and potentially fitness, may provide opportunities to reduce health disparities among children, contributing to improved long-term health outcomes among Wisconsin adults.
Background: Despite the interest in the impact of overweight and obesity on public health, little is known about the social and economic impact of being born large for gestational age or macrosomic. Both conditions are related to maternal obesity and/or gestational diabetes mellitus (GDM) and associated with increased morbidity for mother and child in the perinatal period. Poorly controlled diabetes during pregnancy, pre- pregnancy maternal obesity and/or excessive maternal weight gain during pregnancy are associated with intermittent periods of fetal exposure to hyperglycemia and subsequent hyperinsulinemia, leading to increased birth weight (e.g., macrosomia), body adiposity, and glycogen storage in the liver. Macrosomia is associated with an increased risk of developing obesity and type 2 diabetes mellitus later in life.
Objective: Provide insight in the short-term health-economic impact of maternal overweight, GDM, and related macrosomia. To this end, a health economic framework was designed. This pilot study also aims to encourage further health technology assessments, based on country- and population-specific data.
Results: The estimation of the direct health-economic burden of maternal overweight, GDM and related macrosomia indicates that associated healthcare expenditures are substantial. The calculation of a budget impact of GDM, based on a conservative approach of our model, using USA costing data, indicates an annual cost of more than $1,8 billion without taking into account long-term consequences.
Conclusion: Although overweight and obesity are a recognized concern worldwide, less attention has been given to the health economic consequences of these conditions in women of child-bearing age and their offspring. The presented outcomes underline the need for preventive management strategies and public health interventions on life style, diet and physical activity. Also, the predisposition in people of Asian ethnicity to develop diabetes emphasizes the urgent need to collect more country-specific data on the incidence of macrosomic births and health outcomes. In addition, it would be of interest to further explore the long-term health economic consequences of macrosomia and related risk factors.
Overweight and obesity are a public health problem with a multifactorial aetiology. The objective of this study was to evaluate risk factors for overweight and obesity in children at 6 years of age, including type of delivery and breastfeeding.
This study relates to a cohort of 672 mother-baby pairs who have been followed from birth up to 6 years of age. The sample included mothers and infants seen at all ten maternity units in a large Brazilian city. Genetic, socioeconomic, demographic variables and postnatal characteristics were analyzed. The outcome analyzed was overweight and/or obesity defined as a body mass index greater than or equal to +1 z-score. The sample was stratified by breastfeeding duration, and a descriptive analysis was performed using a hierarchical logistic regression. P-values of <0.05 were considered significant.
Prevalence rates (PR) of overweight and obesity among the children were 15.6% and 12.9%, respectively. Among the subset of breastfed children, factors associated with the outcome were maternal overweight and/or obesity (PR 1.92; 95% confidence interval "95% CI" 1.15-3.24) and lower income (PR 0.50; 95% CI 0.29-0.85). Among children who had not been breastfed or had been breastfed for shorter periods (less than 12 months), predictors were mothers with lower levels of education (PR 0.39; 95% CI 0.19-0.78), working mothers (PR 1.83; 95% CI 1.05-3.21), caesarean delivery (PR 1.98; 95% CI 1.14 - 3.50) and maternal obesity (PR 3.05; 95% CI 1.81 - 5.25).
Maternal obesity and caesarean delivery were strongly associated with childhood overweight and/or obesity. Lower family income and lower levels of education were identified as protective factors. Breastfeeding duration appeared to modify the association between overweight/obesity and the other predictors studied.
The increasing rate of maternal obesity provides a major challenge to obstetric practice. Maternal obesity can result in negative outcomes for both women and fetuses. The maternal risks during pregnancy include gestational diabetes and preeclampsia. The fetus is at risk for stillbirth and congenital anomalies. Obesity in pregnancy can also affect health later in life for both mother and child. For women, these risks include heart disease and hypertension. Children have a risk of future obesity and heart disease. Women and their offspring are at increased risk for diabetes. Obstetrician-gynecologists are well positioned to prevent and treat this epidemic.
Objective:
To estimate whether prepregnancy body mass index (BMI) is related to infant mortality and whether adherence to weight gain recommendations mitigates the relationship between BMI and infant mortality.
Methods:
This was a cohort study using 2012-2013 U.S. national linked birth certificate and infant death files for 38 states and the District of Columbia with the BMI measure, including 6,419,836 singleton births and 36,691 infant deaths (infant mortality rate 5.72/1,000). Prenatal weight gain in three categories was based on adherence to Institute of Medicine recommendations. The outcome measure was infant deaths in the first year of life subdivided into two time periods: neonatal (less than 28 days) and postneonatal (28 days to 1 year).
Results:
With normal prepregnancy weight as a reference, after adjustment, the odds ratio (OR) for an infant death rose from 1.32 (95% confidence interval [CI] 1.27-1.37) for mothers in the obese I category to 1.73 (95% CI 1.64-1.83) for obese III. Higher BMI was related to higher rates of both neonatal and postneonatal mortality. The adjusted OR for the risk of an infant death among singleton, term, vertex births for those gaining less than the recommended weight was 1.07 (95% CI 1.01-1.12) and 1.04 (95% CI 0.99-1.09) for those gaining more than recommended.
Conclusion:
Even after controlling for multiple risks, prepregnancy BMI was strongly related to infant mortality. Efforts to lower the infant mortality rate may benefit from a focus on reducing obesity among women of reproductive age.
Research shows that maternal obesity leads not only to adverse pregnancy outcomes but also can act as a predictor of poor health of future generations. The Public Health Madison & Dane County Fetal and Infant Mortality Review Board observed poor health associated with prepregnancy BMI > or = 25, prompting further exploration of this issue in the Dane County, Wisconsin population.
This is a descriptive epidemiologic study of the problem of maternal overweight defined as prepregnancy BMI > or = 25 in Dane County.
Data were abstracted from the Secure Public Health Electronic Records Environment (SPHERE) on births in Dane County in 2011. Risk ratios were used to determine associations between race, education, parity, gravidity, and place of residence and maternal overweight. A t test was completed to determine differences in mean age of overweight and healthy weight mothers.
Approximately half (50.6%) of Dane County mothers in 2011 were overweight or obese prepregnancy. Results showed increased risk of overweight for black mothers and multiparous/multigravidous mothers. There was no difference in mean age of overweight and healthy weight mothers. Overweight rates varied considerably by ZIP code of residence.
Rates of maternal overweight vary significantly in Dane County by social and demographic factors. This information can be used to design and target interventions and monitor trends over time.
Studies using vital records-based maternal weight data have become more common, but the validity of these data is uncertain.
We evaluated the accuracy of prepregnancy body mass index (BMI) and gestational weight gain (GWG) reported on birth certificates using medical record data in 1204 births at a teaching hospital in Pennsylvania from 2003 to 2010. Deliveries at this hospital were representative of births statewide with respect to BMI, GWG, race/ethnicity, and preterm birth. Forty-eight strata were created by simultaneous stratification on prepregnancy BMI (underweight, normal weight/overweight, obese class 1, obese classes 2 and 3), GWG (<20th, 20-80th, >80th percentile), race/ethnicity (non-Hispanic white, non-Hispanic black), and gestational age (term, preterm).
The agreement of birth certificate-derived prepregnancy BMI category with medical record BMI category was highest in the normal weight/overweight and obese class 2 and 3 groups. Agreement varied from 52% to 100% across racial/ethnic and gestational age strata. GWG category from the birth registry agreed with medical records for 41-83% of deliveries, and agreement tended to be the poorest for very low and very high GWG. The misclassification of GWG was driven by errors in reported prepregnancy weight rather than maternal weight at delivery, and its magnitude depended on prepregnancy BMI category and gestational age at delivery.
Maternal weight data, particularly at the extremes, are poorly reported on birth certificates. Investigators should devote resources to well-designed validation studies, the results of which can be used to adjust for measurement errors by bias analysis.
: To examine the independent contribution of risk factors developing during pregnancy to subsequent risk of obesity in young children.
: We conducted a historical cohort study using data from electronic medical records of mothers and their 3,302 singleton offspring born between 2004 and 2007 at a community-based obstetric facility who attended a 4-year well visit at a pediatric practice network. The child's body mass index (BMI) z score at age 4 years was studied in relation to the mother's gestational weight gain, gestational diabetes mellitus, gestational hypertension or preeclampsia, and prenatal tobacco use. Institute of Medicine categories defined excess and inadequate gestational weight gain at term. Analysis of variance and multiple linear regression were used to test their independent relation to BMI.
: Mothers were white (39%), African American (46%), and of Hispanic ethnicity (11%); 46% were privately insured. The association of net gestational weight gain with the child's BMI z score was significant after adjustment for prepregnancy maternal factors (P<.001); gestational diabetes mellitus, gestational hypertension, and tobacco use were not significant in adjusted models. Children of mothers with excess gestational weight gain had a higher mean BMI z score (P<.001) but a significant association was observed only for inadequate gestational weight gain after adjusting for prepregnancy BMI and other covariates. Prepregnancy BMI (P<.001), Hispanic ethnicity (P<.001), and being married (P<.05) were independently associated with increasing BMI z score of the offspring.
: Preconception maternal factors had a greater influence on child obesity than prenatal factors. The gestational weight gain category was independently related to BMI z score of 4 year olds, but this association was significant only for mothers with inadequate gestational weight gain.
: II.
Pre-pregnancy obesity poses risks to both pregnant women and their infants. This study used a large population-based data source to examine trends, from 1993 through 2003, in the prevalence of pre-pregnancy obesity among women who delivered live infants.
Data from the Pregnancy Risk Assessment Monitoring System in nine states were analyzed for trends in pre-pregnancy obesity (BMI>29.0 kg/m2) overall and by maternal demographic and behavioral characteristics. Pre-pregnancy BMI was calculated from self-reported weight and height on questionnaires administered after delivery, and demographic characteristics were taken from linked birth certificates. The sample of 66,221 births was weighted to adjust for survey design, non-coverage, and non-response, and it is representative of all women delivering a live birth in each particular state. The sampled births represented 18.5% of all births in the United States.
Pre-pregnancy obesity increased 69.3% during the study period, from 13.0% in 1993 to 1994 to 22.0% in 2002 to 2003. The percentage increase ranged from 45% to 105% for individual states. Subgroups of women with the highest prevalence of obesity in 2002 to 2003 were those who were 20 to 29 years of age, black, had three or more children, had a high school education, enrolled in Women, Infants, and Children, or were non-smokers. However, all subgroups of women examined experienced at least a 43% increase in pre-pregnancy obesity over this time period.
The prevalence of pre-pregnancy obesity is increasing among women in these nine states, and this trend has important implications for all stages of reproductive health care.
Obesity is an important risk factor for cardiovascular diseases and non-insulin-dependent diabetes, which are chronic diseases that afflict American Indians and Alaska Natives today. Because American Indians are not represented in most national health and nutrition surveys, there is a paucity of data on actual prevalence of obesity in American Indians. We estimated prevalence of overweight and obesity for American Indian adults, school-age children, and preschool children from existing data. The prevalence of obesity in adults was estimated from self-reported weights and heights obtained from a special survey of American Indians performed as part of the 1987 National Medical Expenditure Survey. Prevalence of obesity in American Indians was 13.7% for men and 16.5% for women, which was higher than the US rates of 9.1% and 8.2%, respectively. Obesity rates in American Indian adolescents and preschool children were higher than the respective rates for US all-races combined.
The purpose of this study was to evaluate the changing prevalence of maternal obesity in an urban center.
The prevalence of obesity in 31,542 pregnancies from January 1986 to December 1996 (group 1) was compared with the prevalence of obesity in 15,600 pregnancies between January 1997 and June 2001 (group 2). Maternal weight was divided into two groups according to measurements performed at delivery (<or=200 pounds and >200 pounds). Women who weighed >or=200 pounds were divided into subgroups for analysis (201-250 pounds, 251-300 pounds, and >300 pounds). The incidence of obesity by weight group was evaluated for a change over time; the impact of race and socioeconomic status was analyzed. A probability value of <.05 was considered significant.
Maternal obesity was significantly more common in group 2 (>200 pounds: 28% vs 21%; relative risk, 1.3; 95% CI, 1.3-1.4; 201-250 pounds: 20% vs 16%; relative risk, 1.3; 95% CI, 1.2-1.3; 251-300 pounds: 5.5% vs 3.7%; relative risk, 1.5; 95% CI, 1.3-1.6; >300 pounds: 1.6% vs 1.2%; relative risk, 1.4; 95% CI,1.2-1.7; P <.001 for each). Obesity was most common in African American women (>200 pounds, 28.1%; 201-250 pounds, 20.5%; 251-300 pounds, 5.5%; and >300 pounds, 2.1 %). The prevalence of obesity increased most among African American women (>200 pounds: 35 % vs 25%; relative risk, 1.4; 95% CI, 1.4-1.5; 201-250 pounds: 25 % vs 18%; relative risk, 1.4; 95% CI, 1.3-1.5; 251-300 pounds: 7.3 % vs 4.6%; relative risk, 1.6; 95% CI, 1.4-1.6; >300 pounds: 2.7% vs 1.8%; relative risk, 1.5; 95% CI, 1.3-1.9; P <.001 for each), and it decreased in Asian women (>200 pounds: 6.8% vs 11%; relative risk, 0.6; 95% CI, 0.4-0.9; P <.05; 201-250 pounds: 6.3% vs 9.7%; relative risk, 0.6; 95% CI, 0.4 -1.1; P >.05; 251-300 pounds: 0.6% vs 1%; relative risk, 0.6; 95% CI, 0.1- 2.9; P >.05; >300 pounds: 0.0% vs 0.3%). The increase in weight over time remained statistically significant after being controlled in multivariate analysis for socioeconomic status and race. Women with milder obesity (201-250 pounds prepregnancy weight) were at increased risk for preeclampsia, gestational and insulin-dependent diabetes mellitus, advanced gestational age (>or=42 weeks), fetal macrosomia, and cesarean delivery (P <.001 for each), with increasing weight being associated with higher risk.
Obesity that complicates pregnancy has increased significantly over the past 15 years. The risk of perinatal complications increases with increasing maternal pregravid weight; even those women with moderate obesity are at increased risk of adverse outcomes.
Wisconsin Department of Health Services
- Wish Query
WISH Query: Birth Counts Module. Wisconsin Department of Health Services; 2014. https://
www.dhs.wisconsin.gov/wish/birth/form.htm [Accessed Sept. 27, 2016]