Severe Obesity in Young Women and Reproductive Health: The Danish National Birth Cohort

The University of Adelaide, Australia
PLoS ONE (Impact Factor: 3.23). 12/2009; 4(12):e8444. DOI: 10.1371/journal.pone.0008444
Source: PubMed


Little is known about reproductive health in severely obese women. In this study, we present associations between different levels of severe obesity and a wide range of health outcomes in the mother and child.
From the Danish National Birth Cohort, we obtained self-reported information about prepregnant body mass index (BMI) for 2451 severely obese women and 2450 randomly selected women from the remaining cohort who served as a comparison group. Information about maternal and infant outcomes was also self-reported or came from registers. Logistic regression was used to estimate the association between different levels of severe obesity and reproductive outcomes.
Subfecundity was more frequent in severely obese women, and during pregnancy, they had an excess risk of urinary tract infections, gestational diabetes, preeclampsia and other hypertensive disorders which increased with severity of obesity. They tended to have a higher risk of both pre- and post-term birth, and risk of cesarean and instrumental deliveries increased across obesity categories. After birth, severely obese women more often failed to initiate or sustain breastfeeding. Risk of weight retention 1.5 years after birth was similar to that of other women, but after adjustment for gestational weight gain, the risk was increased, especially in women in the lowest obesity category. In infants, increasing maternal obesity was associated with decreased risk of a low birth weight and increased risk of a high birth weight. Estimates for ponderal index showed the same pattern indicating an increasing risk of neonatal fatness with severity of obesity. Infant obesity measured one year after birth was also increased in children of severely obese mothers.
Severe obesity is correlated with a substantial disease burden in reproductive health. Although the causal mechanisms remain elusive, these findings are useful for making predictions and planning health care at the individual level.

Download full-text


Available from: Jørn Olsen
  • Source
    • "meses de PP) -Diferença média entre a retenção inicial (15 dias de PP) e final (9 meses de PP): 1,6 kg -RPPP: 19,2% das mulheres estudadas apresentaram aos 9 meses RPPP ≥ 7,5 kg -Redução absoluta de peso: observada em mulheres com menos de 30% gordura corporal, < 20 anos de idade, primíparas e solteiras -O momento de maior diminuição do peso corporal no PP foi às 2-3 semanas PP (-8,00 kg) -A média de kg retidos foi de 3,31 + 3,01 kg na 24-25ª semana de PP -RPPP média: 1,1 ± 3,6 kg (12 meses de PP) e 7,6 ± 7,4 kg (15 anos de PP) -As mulheres que retiveram mais peso (> 2,2 kg) foram as que tiveram maior ganho de peso gestacional (16,0 ± 4,1 kg) -IMC pré-gestacional não apresentou relação com a RPPP -RPPP média: 1,31 kg ± 5,8 kg (aos 12 meses de PP) -24% das mulheres tiveram RPPP ≥ 4,55kg nos 12 meses de PP -26% ganharam mais que 2,25kg no período de 12 a 24 meses de PP -15% das mulheres foram classificadas na categoria de RPPP elevada quando observado o período de 12 a 24 meses de PP -RPPP média (1 ano de PP): 1,18 kg -RPPP média (3 anos de PP): 4,66 kg -RPPP ≥ 4 kg (3 anos de PP): em 49,3% das mulheres continua Quadro 2. continuação Autor, ano Mamun et al., 2010 26 Nacach e Rodríguez- Medina, 2011 40 Nohr et al., 2009 41 Onyango et al., 2011 21 Rode et al., 2012 19 Rooney e Schauberger, 2002 42 Siega-Riz et al., 2010 4 Soltani e Fraser, 2000 25 Zanotti, 2012 44 Formas de avaliação da rPPP Desfecho IMC – Adequado < 25 kg/m2; Sobrepeso: 25 a 29 kg/m2; Obesidade: ≥ 30 kg/m2) – análise de forma contínua RPPP: > 4,5 kg aos 12 meses de PP (a) PPP: diferença entre PPG e peso nas entrevistas de PP (b) Categorizado: RPPP: ≥ 5 kg Perda de peso no PP: ≥ 5 kg PPP -diferença entre o peso em algum momento do PP menos peso no baseline (a) RPPP: mudança de peso em 1 ano de PP em relação ao peso antes da gestação -análise estratificada de acordo com IMC pré-gestacional. (b) RPPP categorizada: menor que -10 kg, entre -10kg e -5.1 kg, entre -5kg e -0,1kg, 0 kg, 0,1 a 5 kg, 5.1 a 10 kg, maior de 10 kg de acordo com as faixas de IMC pré-gestacional (a) RPP: peso da 1ª consulta de pré-natal menos o último peso conhecido (mudança de peso) e IMC do último acompanhamento. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Trata-se uma revisão sistemática de trabalhos científicos que estudaram a retenção de peso pós-parto. A identificação dos artigos foi feita nas bases de dados Medline, Lilacs e Biblioteca Digital de Teses e Dissertações, entre 2000 e 2013. As principais informações avaliadas foram: autor, ano de publicação, tamanho da amostra, ano de coleta, perdas e sua análise, idade, tempo de seguimento, peso no baseline e no pós-parto, métodos de avaliação da retenção de peso e principais resultados. Foram selecionados 20 estudos, destes 25% (n = 5) eram nacionais. Em relação à forma de análise, em alguns trabalhos, o mesmo desfecho foi analisado de diferentes maneiras, de forma contínua e categórica. Dos trabalhos selecionados, 45% (n = 9) analisaram o peso retido apenas de forma contínua, 5% (n = 1) apenas por categorias e 40% (n = 8) de ambas as maneiras. Um dos estudos utilizou distribuição percentilar e outro avaliou de forma contínua, categórica e por indicadores de redução absoluta e relativa de peso. Em conclusão, os resultados encontrados evidenciam a escassez de informações definidas acerca da avaliação antropométrica das mulheres no pós -parto, indicando a necessidade de elaboração de propostas nacionais, coerentes com a realidade de nossa população.
    Preview · Article · Jan 2015 · Ciência & Saúde Coletiva
  • Source
    • "Analyses involving secondary tooth eruption were performed using data from the Danish National Birth Cohort (7). The genotype data were derived from two on-going GWASs of preterm birth (56) and obesity (57). The study combined all observations between age 6 and 14 years (starting with the 6th and stopping with the 14th birthday), the time period when eruption of permanent dentition usually occurs. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Twin and family studies indicate that the timing of primary tooth eruption is highly heritable, with estimates typically exceeding 80%. To identify variants involved in primary tooth eruption we performed a population based genome-wide association study of 'age at first tooth' and 'number of teeth' using 5998 and 6609 individuals respectively from the Avon Longitudinal Study of Parents and Children (ALSPAC) and 5403 individuals from the 1966 Northern Finland Birth Cohort (NFBC1966). We tested 2,446,724 SNPs imputed in both studies. Analyses were controlled for the effect of gestational age, sex and age of measurement. Results from the two studies were combined using fixed effects inverse variance meta-analysis. We identified a total of fifteen independent loci, with ten loci reaching genome-wide significance (p<5x10(-8)) for 'age at first tooth' and eleven loci for 'number of teeth'. Together these associations explain 6.06% of the variation in 'age of first tooth' and 4.76% of the variation in 'number of teeth'. The identified loci included eight previously unidentified loci, some containing genes known to play a role in tooth and other developmental pathways, including a SNP in the protein-coding region of BMP4 (rs17563, P= 9.080x10(-17)). Three of these loci, containing the genes HMGA2, AJUBA and ADK, also showed evidence of association with craniofacial distances, particularly those indexing facial width. Our results suggest that the genome-wide association approach is a powerful strategy for detecting variants involved in tooth eruption, and potentially craniofacial growth and more generally organ development.
    Full-text · Article · Sep 2013 · Human Molecular Genetics
  • Source
    • "Obese women tend to have a longer gestation and are more likely to deliver beyond 41 weeks of pregnancy, especially when BMI reaches 35 kg/m 2 or more (Usha Kiran et al., 2005; Graves et al., 2006; Bhattacharya et al., 2007; Stotland et al., 2007; Denison et al., 2008; Caughey et al., 2009; Nohr et al., 2009). "
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: the incidence of obesity increases in all developed countries to frightful percentages, also in women of reproductive age. Maternal obesity is associated with important obstetrical complications; and this group also exhibits a higher incidence of prolonged pregnancies and labours. OBJECTIVE: to review the literature on the pathophysiology of onset and progression of labour in obese woman and translate this knowledge into practical recommendations for clinical management. METHODS: a literature review, in particular a critical summary of research, in order to determine associations, gaps or inconsistencies in this specific but limited body of research. FINDINGS: the combination of a higher incidence of post-term childbirths and increased inadequate contraction pattern during the first stage of labour suggests an influence of obesity on myometrial activity. A pathophysiologic pathway for altered onset and progression of labour in obese pregnant women is proposed. CONCLUSIONS: analysis of the literature shows that obesity is associated with an increased duration of pregnancy and prolonged duration of first stage of labour. IMPLICATIONS FOR PRACTICE: an adapted clinical approach is suggested in these patients.
    Full-text · Article · Feb 2013 · Midwifery
Show more