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

Obesity is a global health problem that is increasing in prevalence. The World Health Organization characterizes obesity as a pandemic issue, with a higher prevalence in females than males. Thus, many pregnant patients are seen with high body mass index (BMI). Obesity during pregnancy is considered a high-risk state because it is associated with many complications. Compared with normal-weight patients, obese patients have a higher prevalence of infertility. Once they conceive, they have higher rate of early miscarriage and congenital anomalies, including neural tube defects. Besides the coexistence of preexisting diabetes mellitus and chronic hypertension, obese women are more likely to have pregnancy-induced hypertension, gestational diabetes, thromboembolism, macrosomia, and spontaneous intrauterine demises in the latter half of pregnancy. Obese women also require instrument or Cesarean section delivery more often than average-weight women. Following Cesarean section delivery, obese women have a higher incidence of wound infection and disruption. Irrespective of the delivery mode, children born to obese mothers have a higher incidence of macrosomia and associated shoulder dystocia, which can be highly unpredictable. In addition to being large at birth, children born to obese mothers are also more susceptible to obesity in adolescence and adulthood. Prevention is the best way to prevent this problem. As pregnancy is the worst time to lose weight, women with a high BMI should be encouraged to lose weight prior to conceiving. During preconception counseling, they should be educated about the complications associated with high a BMI. Obese women should also be screened for hypertension and diabetes mellitus. In early pregnancy, besides being watchful about the higher association of miscarriage, obese women should be screened with ultrasound for congenital anomalies around 18 to 22 weeks. The ultrasound should be repeated close to term to check on the estimated fetal weight to rule out macrosomia. Obese pregnant women are screened for gestational diabetes around 24 to 28 weeks. During the second half of pregnancy, one needs to closely watch for signs and symptoms of pregnancy-induced hypertension. Once in labor, an early anesthesia consultation is highly recommended irrespective of delivery mode. When Cesarean section is performed, many obstetricians prefer an incision above the pannus to avoid skin infection. However, the incision should be decided upon the discretion of the surgeon. Peripartum, special attention is given to avoid thromboembolism by using compression stockings and early ambulation.
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PMID:Maternal obesity and pregnancy. 1882 17

The aim of this study was to assess the impact of isolated obesity on the outcome of intracytoplasmic sperm injection (ICSI). A total of 775 patients undergoing 1113 ICSI cycles were categorized on the basis of body mass index (BMI): group 1 (BMI 18.5-24.9 kg/m(2); normal weight; n = 627 cycles), group 2 (BMI 25.0-29.9 kg/m m(2); overweight; n = 339 cycles) and group 3 (BMI >or=30 kg/m(2); obese; n = 147 cycles). Sixty-three (10.0%) cycles in group 1, 53 (15.6%) cycles in group 2 and 26 cycles (17.7%) in group 3 were cancelled (P < 0.05 for group 1 versus groups 2 and 3). Despite the significantly higher total gonadotrophin consumption in groups 2 and 3 compared with group 1, the mean serum oestradiol level on the day of human chorionic gonadotrophin administration was significantly higher in group 1 (P < 0.05). The number of cumulus-oocyte complexes, metaphase II oocytes, and two-pronucleated oocytes were significantly lower in group 3 compared with group 1 (P < 0.05). However, fertilization rate, the mean number of embryos transferred, the mean number of grade 1 embryos transferred, clinical pregnancy, implantation, multiple pregnancy and miscarriage rates were comparable among the three groups. The rate of cycles with cryopreservable embryos was significantly lower in groups 2 and 3 compared with group 1 (P < 0.05).
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PMID:Impact of isolated obesity on ICSI outcome. 1885 16

Obesity and overweight are common conditions that have consequences not only on general health but also to a great extent on reproductive health. There is a high prevalence of obese women in the infertile population and numerous studies have highlighted the link between obesity and infertility. Obesity contributes to anovulation and menstrual irregularities, reduced conception rate and a reduced response to fertility treatment. It also increases miscarriage and contributes to maternal and perinatal complication. Reduction of obesity, particularly abdominal obesity, is associated with improvements in reproductive functions; hence, treatment of obesity itself should be the initial aim in obese infertile women before embarking on ovulation-induction drugs or assisted reproductive techniques. While various strategies for weight reduction, including diet, exercise, pharmacological and surgical intervention exist, lifestyle modification continues to be of paramount importance.
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PMID:Impact of obesity on female fertility and fertility treatment. 1907 20

Anandamide (arachidonoyl ethanol amide, AEA) is an endocannabinoid, acting on CB1 and CB2 receptors. Elevated plasma AEA concentrations in humans have been associated amongst others with obesity, psychological disorders and miscarriage. The occurrence in human plasma of ethanol amides of other unsaturated and saturated fatty acids, including oleic acid and palmitic acid, has also been reported. Most data available on anandamide and other fatty acid ethanol amides (FAEA) until now have been generated by using the LC-MS/MS methodology. Here, we describe a stable-isotope dilution GC-MS/MS method for the quantitative determination of AEA, oleic acid ethanol amide (OEA) and palmitic acid ethanol amide (PEA) in human plasma using their stable-isotope labeled analogs as internal standards. Other FAEA were found in plasma and their concentration was estimated. The present method involves a single solvent extraction of FAEA and their internal standards from plasma (50-1000 microl) with toluene, derivatization to the pentafluorobenzamide pentafluoropropionyl derivatives (FAEA-PFBz-PFP), and simultaneous quantification by selected reaction monitoring of the carboxylate anions produced by collision-induced dissociation of the parent ions [M-PFBz](-). The present method was fully validated for anandamide. Thus, accuracy and imprecision of the method were within the range of 100+/-20% and less than 20%, respectively, in the range investigated (0-4 nM). Mean overall recovery was 90+/-3%. The LOQ and LOD values of the method were determined to be 0.25 nM of added AEA in plasma samples and 400 amol of injected AEA-PFBz-PFP derivative, respectively. In plasma of 16 healthy individuals AEA concentration was measured to be 1.35+/-0.32 nM. This finding is concordant to literature AEA plasma concentrations as measured by LC-MS/MS. The plasma concentrations of OEA, PEA and other FAEA are higher than that of AEA. This GC-MS/MS method is straightforward, accurate, precise, highly specific for FAEA and useful in basic and clinical research.
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PMID:Targeted stable-isotope dilution GC-MS/MS analysis of the endocannabinoid anandamide and other fatty acid ethanol amides in human plasma. 1941 83

Polycystic ovary syndrome (PCOS), one of the most frequent endocrine diseases, affects approximately 5%-10% of women of childbearing age and constitutes the most common cause of female sterility regardless of the need or not for treatment, a change in lifestyle is essential for the treatment to work and ovulation to be restored. Obesity is the principal reason for modifying lifestyle since its reduction improves ovulation and the capacity for pregnancy and lowers the risk of miscarriage and later complications that may occur during pregnancy (gestational diabetes, pre-eclampsia, etc). When lifestyle modification is not sufficient, the first step in ovulation induction is clomiphene citrate. The second-step recommendation is either exogenous gonadotrophins or laparoscopic ovarian surgery. Recommended third-line treatment is in vitro fertilization. Metformin use in PCOS should be restricted to women with glucose intolerance.
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PMID:Current trends in the treatment of polycystic ovary syndrome with desire for children. 1953 11

This review summarizes the epidemiology and consequences of maternal smoking in pregnancy, with emphasis on the adverse effects on birth outcomes. In developed countries, approximately 15%, and in developing countries, approximately 8% of women smoke cigarettes, and adolescents and women from lower socioeconomic groups are more likely than other women to smoke while pregnant. Maternal smoking during pregnancy is the largest modifiable risk factor for intrauterine growth restriction. A meta-analysis of recent studies showed that the pooled estimate for reduction of mean birthweight was 174 g (95% confidence limits 132-220 g). Other studies confirm a weaker association between maternal smoking and preterm birth. The population attributable risk of low birthweight due to maternal smoking in the UK is estimated to be 29-39%. Tobacco smoke toxins damage the placenta and may lead to placental abruption, abortion or placenta praevia. Infants of mothers who smoke in pregnancy are at an increased risk of respiratory complications including asthma, obesity and, possibly, behavioral disorders. These effects may be dose-related, as there is good evidence that mean birthweight decrements are greater with increased numbers of cigarettes smoked during pregnancy. Cotinine is a useful indicator of tobacco smoke exposure in pregnant women and higher levels in body fluids have been related to lower birthweights. Maternal genetic polymorphisms of the cytochrome P (CYP)450 and glutathione-S-transferase (GST) subfamilies of metabolic genes influence the magnitude of the effect of nicotine exposure on birth outcomes through their influence on nicotine metabolism. Greatly increased risk of cigarette smoke-induced diseases, including low birthweight, has been found in individuals with susceptible genotypes. Interventions to control maternal smoking are also considered.
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PMID:Pregnancy, smoking and birth outcomes. 1980 11

Diabetes is a chronic disease with increasing incidence in recent years in parallel with the obesity epidemic. Diabetes can cause damage to many target organs and pregnancy in women with pregestational diabetes is considered a high risk pregnancy and constitutes a special challenge. Pregestational diabetes increases the risk of pregnancy complications to the mother, fetus and newborn infant. The duration and type of diabetes, its severity, the occurrence of chronic complications and the level of glucose control are the major factors influencing pregnancy outcome. Diabetes substantially increases the risk of spontaneous abortion and congenital malformations. In order to minimize these risks, it is important that all women with pregestational diabetes will receive appropriate preconception counseling and treatment.
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PMID:[Preconception care and counseling for women with diabetes and those at risk for diabetes]. 1984 33

Rates of obesity among the pregnant population have increased substantially and adiposity has a damaging effect on every aspect of female reproductive life. This review summarises epidemiological data concerning obesity-related complications of pregnancy. Obesity is linked to a number of adverse obstetric outcomes as well as increased maternal and neonatal morbidity and mortality. These complications include miscarriage, congenital abnormalities, pre-eclampsia, gestational diabetes mellitus, iatrogenic preterm delivery, postdates pregnancy with increased rates of induction of labour, caesarean section, postpartum haemorrhage, shoulder dystocia, infection, venous thromboembolism, and increased hospital stay. It is important to consider obese pregnant women as a high risk group with a linear increase in risk of complications associated with their degree of obesity. Their obstetric management should be consultant-led and involve a multidisciplinary team approach to improve outcome.
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PMID:Obstetric management of obesity in pregnancy. 1988 Mar 62

This paper provides a review of literature on the effects of shift work on physical health, mental health and well-being. In Europe, 20% of the workforce is involved in irregular work schedules. Up to 70% of workers report problems, with increasing age, associated with more difficulties in adjusting to shift work. Epidemiologic studies on large populations have suggested a relation between employment in shift work and the incidence of sleep disorders, cancer, cardiovascular disease, diabetes, obesity, metabolic syndrome, reduced fecundity, preterm births, low birth weight, spontaneous abortion, work and traffic accidents, etc. Shift work exerts major influences on the physiological functions of the human body, mediated by the disruption of circadian rhythms.
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PMID:[Morbidity of irregular work schedules]. 1989 78

Pregnancy in peri- and postmenopausal women is associated with an increased risk of complications and represents several challenges in terms of clinical management. Women in these age groups typically fall into one of two distinct groups, those who have conceived following assisted reproductive techniques, using ovum donation and those who have conceived spontaneously. While both have age in common, they differ in terms of additional risk factors. Recipients of assisted reproductive technologies have pregnancy risks associated with that treatment, but are at lower risks of a fetus affected by aneuploidy. Furthermore, they have been rigorously screened for medical complications, but are more likely to be primiparous and have multiple pregnancies. In contrast, women conceiving spontaneously are more likely to be of high parity and have additional medical complications such as obesity, hypertension or diabetes. In addition to the increased risk of antenatal complications such as miscarriage, ectopic pregnancies, gestational diabetes and hypertension, these women have a high risk of unexplained stillbirth. They also have a very high rate of Caesarean section. All these risk factors interact to modify clinical management. However, there are no randomized trials available to guide clinical management, thus decisions must be made on a case-by-case basis.
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PMID:Pregnancy in peri- and postmenopausal women: challenges in management. 1993 69


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