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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There are currently numerous well-woman clinics in Britain which emphasize a specific aspect of health care, including cervical cancer screening (134 centers), family planning (142 centers), antenatal care (162 clinics), and venereal disease control (15 clinics). However, care provided in these clinics is fragmentary and excludes certain population groups from coverage. For example, cervical cancer smears are largely sought by upper class women under age 35, although this cancer has a higher incidence among older women from the lower social classes. Similarly, family planning clinics are not attracting women at highest risk of repeat abortion. Antenatal clinics, although effective in reducing perinatal and maternal mortality, exclude women beyond the childbearing years. At present, there are less than 10 comprehensive well-woman clinics in Britain. However, an estimated 17 million women could benefit from such a service, especially if cervical cytology screening was absorbed within it. A comprehensive clinic could focus on medical problems common to women, including menopause, frigidity, child abuse, obesity, thyroid disease, and depression. Omissions created by fragmented care, such as failure to test for conditions like anemia, could be avoided. The Manchester well-woman clinic, set up in 1981, provides an example of the role such clinics could play. The clinic is targeted at women who rarely see a general practitioner, e.g., poor, infertile, older women. Its emphasis is on the prevention and early detection of disease. Treatment is limited to self-help support groups and discussions with staff; however, new attendees are screened by a physician and nurse. 99% of attendees were found to have at least 1 medical problem. 2/3 of these problems, including breast problems, vaginal discharge, menopause problems, depression, and headache, were not already being treated. This experience suggests that there is an untapped need for such a facility, especially among women between menopause and old age.
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PMID:Evaluating well-woman clinics. 688 41

200 cases of bilateral tubal occlusion by minilaparotomy after noninfected spontaneous abortion and 1 year follow-up were reviewed. 45% of the patients had a previous abortion. Tubal occlusion was carried out using the same anesthesia for uterine curettage and Pomeroy's technique. Complications may arise in abortions with an IUD in situ, with failure to use a uterine mobilizer in the intrapelvic uterus, obesity, and lack of experience on the part of the surgeon. There was 1 case of pregnancy which occurred, indicating a 0.5% failure rate. Postabortion sterilization should be included in all family planning programs. (author's)
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PMID:[Salpingoclasia by minilaparotomy following spontaneous abortion]. 732 22

A case-control study was conducted to investigate risk factors for eclampsia. A total of 66 cases of eclampsia were ascertained from deliveries between 1977 and 1992 at two hospitals in Houston, Texas, based on the criteria defined by the American College of Obstetrics and Gynecology. Cases were matched to nonpreeclamptic controls on a 4:1 ratio on the basis of hospital and month of delivery. The ratio of eclampsia cases to number of deliveries over the study period was 0.63 per 1,000. In a logistic regression model, risk factors for eclampsia included 1) two or fewer prenatal care visits (odds ratio (OR) = 6.10, 95% confidence interval (CI) 2.26-16.41), 2) urinary tract infection (OR = 4.23, 95% CI 1.27-14.06), 3) primigravidity (OR = 2.87, 95% CI 0.97-8.44), 4) obesity (OR = 2.49, 95% CI 0.78-7.96), 5) black ethnicity (OR = 2.25, 95% CI 0.88-5.78), 6) history of diabetes (OR = 2.07, 95% CI 0.45-9.62), and 7) age < or = 20 years (OR = 1.55, 95% CI 0.47-5.10). Nulliparity was not shown to be a risk factor for eclampsia when controlled for primigravidity, and neither were previous history of abortion or previous history of pregnancy-induced hypertension. Thus, prior pregnancy itself, independent of outcome and preeclamptic/eclamptic complications, appears to be the protective factor against eclampsia in a subsequent pregnancy.
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PMID:Case-control study of the risk factors for eclampsia. 762 9

A preliminary case-control study was conducted on Saudi women to detect possible risk factors for spontaneous abortion (SA). Two hundred and twenty six consecutive women hospitalised for SA and 226 women admitted for normal delivery and used as controls, were studied. Women with SA were significantly older at menarche (Relative Risk (RR) = 3.2), more frequently married to blood-related husbands (RR = 2.1) and husbands older than 50 years (RR = 2.4). Number of previous abortions related linearly to the risk of aborting spontaneously in the next pregnancy. Compared to primigravidas, the RR was 3.2 if the outcome of the most recent pregnancy was SA, and 0.8 if it was a livebirth. A family history of SA was more common among cases (RR = 4.6). Spontaneous abortion was also associated with daily consumption of more than 150 mg of caffeine, abdominal trauma, infection and fever during pregnancy. No significant association, however, emerged with maternal age, social class, education, exposure to video display terminals, parity, use of contraception, diabetes or obesity. The application of these data in clinical practice and future research needs are discussed.
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PMID:Risk factors for spontaneous abortion: a preliminary study on Saudi women. 793 96

Obese women with polycystic ovary syndrome require higher doses of gonadotrophin for induction of ovulation than their lean counterparts. They also have a lower rate of ovulation and higher prevalence of miscarriage.
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PMID:[The role of body weight and metabolic anomalies in ovulation induction]. 801 8

Forty-four polycystic ovary syndrome (PCO) patients were treated for a total of 61 cycles with intermediate-dose pure follicle stimulating hormone (FSH). Patient selection was based on hyperandrogenism, oligoovulation and physical signs. Patients with multiple-factor infertility were excluded from the study. Seventeen conception cycles occurred in 17 patients (pregnancy cycles). The spontaneous abortion rate was 29.4%. Forty cycles did not result in conception (Nonpregnancy cycles, 23 patients). Treatment was discontinued in four patients who had suboptimal response. Sixteen pregnancies (94%) occurred within the first two treatment cycles. Pregnancy and nonpregnancy cycles were compared for characteristics associated with a successful outcome. The data suggest that (1) an intermediate-dose pure FSH protocol is most likely to be successful among more "classic" PCO patients, those with obesity, high body surface area, elevated luteinizing hormone/FSH ratio and higher testosterone; (2) if pregnancy is to occur, it is most likely to within two treatment cycles; and (3) ovarian hyperstimulation is more likely to occur in nonconception cycles.
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PMID:Proper selection of patients for intermediate-dose pure follicle stimulating hormone. 816 7

Early age at menarche, late age at menopause, and late age at first full-term pregnancy are linked to a modest increase in the risk of developing breast cancer. Some evidence suggests that the earlier the full-term pregnancy, the earlier the period of decreased susceptibility of breast tissue changes begins. Nulliparity is related to an increased risk for breast cancer diagnosed after 40 years old. Multiple full-term pregnancies decrease the risk of breast cancers diagnosed after 40 years regardless of the age at first birth. On the other hand, they may increase the risk for breast cancers diagnosed before 40 years old. Surgical removal of the ovaries protects against breast cancer. Breast feeding apparently protects against breast cancer in China, but a protective effect has not been established in the US. Other than shorter intervals between menstrual periods, which tend to increase the risk, research has not yet made clear the etiologic roles of menstrual cycle characteristics. Other unclear etiologic roles include increased intervals between births, spontaneous and induced abortion, infertility, multiple births at last pregnancy, and hypertension during pregnancy. Researchers tend to accept a mechanism to explain the epidemiologic characteristics of menstrual activity and the increased risk of breast cancer, but no mechanisms have emerged for the other likely risk factors. Greater exposure to estrogen and progesterone simultaneously are linked to early age at menarche, late age at menopause, and shorter menstrual cycle length. So far, data show that long-term combined estrogen/progestin hormone replacement therapy and long-term use of oral contraceptives increase the risk of breast cancer. Moderately increased risks linked to longterm estrogen replacement therapy and obesity in postmenopausal women indicate that estrogen alone influences breast cancer risk. Since much of the research on breast cancer risk factors are inconclusive, more research is needed, especially research examining the probability of prolonged exposure to both estrogens and progesterone concurrently.
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PMID:Reproductive factors and breast cancer. 840 11

Between 1988-1922, data of the nutritional status of pregnant women seen in the Santiago Metropolitan Health Service were analyzed. Underweight (22.2%), normal weight (47.2%), overweight (19.7%) and Obese (15.4%). Four thousand five hundred fifty five pregnant women were studied. Underweight 1136, normal weight 1219, overweight 1100 and obese 1100. Underweight was significantly more frequent in the patients less than 20 years old while overweight and obese was significantly more frequent in the patients over 30 years old. Hypertension (2.6%) was the only significant morbidity factor in the obese group. The overweight and obese groups had earlier menarche, while the obese group had shorter periods. The obese group were associated most frequently with higher parity (75.1%), stillbirth (4.6%), spontaneous abortion (19.5%), induced abortion (3.1%) and high obstetric risk (33.2%). In the normogram used, the underweight patients are abnormally represented at the start of pregnancy. The obese group gained less weight proportionally during pregnancy (overweight and obese 42.8%, underweight and normal 34.7%). The obese group presented more frequently with hypertension (20.4%) and diabetes (0.7%), while the obstetric complications occurred more frequently in the underweight (6.3%). The underwent group had more anemia (45.4%) and premature labor (12.3%). Cesarean section was performed more frequently in the obese group (33.1% versus 21.3% of all the other groups combined. The neonatal birthweight was in direct proportion to the maternal weight, measured by various methods. It is worth noting the importance of microelements in the milk ingestion of the pregnant patients and the influence on their weight.
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PMID:[Influence of body weight in pregnancy and the perinatal results]. 872 43

Obesity has consistently been demonstrated to have a detrimental effect upon the female reproductive system. This review explores the common association of obesity with polycystic ovary syndrome (PCOS), the effect of obesity on the clinical and endocrinological parameters, and the role of insulin resistance in the expression of this disorder. An improvement in menstrual function, a decrease in the clinical androgenic profile, and significant increase in spontaneous pregnancy rates have been reported following weight loss. Obesity is associated with poor pregnancy outcome and miscarriage in both women with PCOS, and in those with normal ovarian morphology. The optimal weight gain during pregnancy remains controversial, but obesity is a risk factor for both maternal and fetal complications, and dietary advice should be offered on an individual basis according to the pre-pregnancy BMI. Weight gain at the time of menopause is common, and dietary advice is paramount as obesity is an independent risk factor for thrombosis, coronary heart disease (CHD), and breast and endometrial cancer. Effective nutritional counselling should be offered at all stages of the female reproductive lifecycle.
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PMID:Obesity and female reproductive function. 924 40

Generally, obesity represents a risk factor for pregnancy and birth. Already the conception rate is lowered. If pregnancy occurs, there is an increased abortion rate and an increase of neural tube defects. The efficiency of prenatal diagnosis is decreased by obesity. In obese women pregnancy is more frequently associated with complications such as chronic hypertension, gestosis, disturbances of carbohydrate metabolism, liver- and cardiac dysfunction. Central obesity has the highest risk probability. Also during birth the risk of complications is dependent upon the degree of obesity. This applies to the whole delivery process, operative deliveries and the perinatal mortality. Operative delivery by cesarean section is associated with a higher complication rate compared with pregnant women with normal weight. The postpartal course of body weight has to be controlled particularly in obese women.
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PMID:[Obesity and pregnancy]. 962 31


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