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

The relationship between maternal plasma levels of beta-endorphin (beta-Ep) during labor and various obstetrical factors was investigated in 115 healthy pregnant women. beta-Ep was determined by radioimmunoassay using double-antibody RIA kit (INCSTAR Corporation, Stillwater, M'S.). The results were as follows: (1) The primiparous women showed a significant increase of maternal plasma levels of beta-Ep at delivery compared with the multiparous women. In addition, the group of women whose Bishop's score at the onset of labor was 5 points or less showed a significant increase of maternal plasma levels of beta-Ep at delivery compared with that in the group of women whose Bishop's score was 6 points or more. (2) The increase in maternal plasma levels of beta-Ep during the first and the second stage of labor was significantly higher in obese women (pre-pregnancy BMI > or = 24) than in normal weight women (pre-pregnancy BMI < 24). In normal weight women in pre-pregnancy, the group of women whose weight gain during pregnancy was 11kg or more showed a significantly higher increase of beta-Ep compared with that in the group of women whose weight gain was less than 11 kg. These results suggest that a stressful delivery caused a significant increase of maternal plasma levels of beta-Ep during labor. Moreover, obesity and marked weight gain during pregnancy caused a remarkable increase in beta-Ep probably due to latent dystocia.
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PMID:[Maternal plasma beta-endorphin levels during labor in relation to maternal obesity]. 795 97

This retrospective case--control study analyses the prevalence and outcome of macrosomia in a part of the underdeveloped world. Out of 6,093 deliveries at a large tertiary care centre, 234 (3.8%) were macrosomic. Maternal risk factors associated with the condition included age over 35, obesity, grand multiparity, postmaturity and impaired glucose tolerance. Operative deliveries were more common as was shoulder dystocia, birth trauma, fetal distress, the need for neonatal intensive care and perinatal loss.
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PMID:Macrosomia: maternal and fetal outcome. 817 32

This study was done to determine if impaired glucose tolerance in pregnancy was associated with increased maternal and neonatal morbidity and if so, whether the increased morbidity was due to the confounding factors of increased maternal age and maternal obesity. It was a retrospective analysis to compare 944 women with impaired glucose tolerance (IGT) in pregnancy with 10,065 women without abnormal glucose tolerance. The incidence of impaired glucose tolerance in pregnancy was 8.6% in this study. Even when maternal age and obesity were excluded, the IGT group had significantly higher risks of labour induction (relative risk, RR, 1.15); Caesarean section (RR: overall 1.43, elective 1.72, emergency 1.31); Caesarean section for dystocia/no progress (RR 1.60); macrosomia (RR 1.69, 1.76, 1.61 for birth-weight > = 97th, 95th, 90th percentiles respectively) and shoulder dystocia (RR 2.84) when compared to the nondiabetics (NDM). The risks of hypertensive disease (RR 1.22) and Caesarean section for fetal distress/thick meconium-stained liquor (RR 1.53) were also higher in the IGT group but these increases were not statistically significant when maternal age and obesity were excluded. There was no significant difference in the rates of low Apgar scores at 1 and 5 minutes between the 2 groups.
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PMID:Impaired glucose tolerance in pregnancy--is it of consequence? 888 44

In summary, fetal macrosomia occurs in almost one third of diabetic pregnancies regardless of class. Abnormal fetal fat stores lead to difficult labor, dystocia, and birth injury as well as postnatal metabolic transition. The abnormal body fat distribution at birth may destine some of these infants to lifelong obesity. Abnormal fetal growth in diabetic pregnancy appears to occur with any elevations in maternal glucose levels, however modest. Detection of macrosomia is therefore a major goal of diabetic pregnancy management.
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PMID:Fetal growth in diabetic pregnancy. 942 92

The objective of this paper is to evaluate the influence of maternal and neonatal factors on the recurrence of gestational diabetes mellitus (GDM). A study was conducted on 164 predominantly Hispanic patients whose index pregnancy was complicated by GDM and whose subsequent consecutive pregnancy was managed at our institution between January 1988 and December 1992. The diagnosis of GDM was based on the criteria recommended by the National Diabetes Data Group using a 100-g oral glucose tolerance test. One-hundred and eleven (68%) of the 164 women had recurrence of GDM. Fifty-three (32%) did not demonstrate recurrence in their subsequent pregnancy. Patients with recurrence had GDM diagnosed earlier (30.3 vs 32.5 weeks, p = 0.03), frequently required insulin (25 vs. 8%, p <0.05) and had more hospital admissions (32 vs. 10% p <0.05) in their index pregnancy compared to women who did not have recurrence of GDM. Women who had recurrence had elevated mean third-trimester plasma glucose values: fasting 87.6 vs. 83 mg/dL, (p = 0.009) and 2-hr postprandial 109.7 vs. 102.2 mg/dL, (p = 0.008). Neonates of patients with recurrence were heavier (3656 vs. 3373 g, p = 0.004) and had an increased incidence of macrosomia (26 vs. 10%, p <0.05). No significant differences were observed in maternal age, prepregnancy body mass index, HbgA1C values, second-trimester blood glucose levels, method of delivery, incidence of shoulder dystocia and Apgar scores between the two groups of women. Hispanic patients with history of GDM have significant risk of recurrence in their subsequent pregnancy. The risk for recurrence in women is increased if GDM is diagnosed earlier, they require insulin, have elevated third-trimester plasma glucose level, and deliver macrosomic infants in their index pregnancy. It appears that obesity does not increase the risk of recurrence of gestational diabetes in Hispanics.
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PMID:Recurrence of gestational diabetes mellitus: identification of risk factors. 947 84

The relationships among maternal weight, gestational weight gain, fetal birth weight and birth injuries have been investigated in connection with 62 cases of shoulder dystocia that involved permanent impairment of the newborn or neonatal demise. A high prevalence of > 13.5 kgs. gestational weight increase between the first and last office visits (62%) obesity expressed as > or = 87 kg. body weight at term (64.1%) and > or = 4000 gm. birth weight (80%) was found in this group of patients. The results indicate that the relationship between excessive maternal and fetal body weights and shoulder dystocia related fetal or neonatal impairment is closer than previous studies have suggested. These results underline the importance of appropriate and intensive nutritional counselling of the mother throughout pregnancy, noting that arrest of the shoulders is only one of those obstetric complications that are closely related to maternal obesity. The findings underline the usefulness of medico-legal reviews in clinical research.
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PMID:Maternal weight and fetal injury at birth: data deriving from medico-legal research. 964 93

Obesity-related metabolic and functional disorders may disturb adaptation process taking place in pregnant women body. Insufficient adaptation may lead to development of several medical complications during pregnancy, labor, delivery, and puerperium. Maternal obesity is associated with increased frequencies of hypertension, preeclampsia, gestational diabetes mellitus, fetal macrosomia, congenital malformations, labor abnormalities (including prolonged second stage of labor, meconium-stained amniotic fluid, FHR abnormalities and shoulder dystocia), postdatism, and cesarean delivery. Operative complications among obese women undergoing cesarean delivery include increased blood loss, prolonged operative time, and increased rates of postoperative infection, thrombophlebitis. Treatment of these complications increases hospital stays and costs. Obese women should be carefully examined by dietetician before conception and cared for dietetically and medically during gestation.
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PMID:[Obesity as an obstetric risk factor]. 1089 90

We prospectively studied pregnancy outcome in 428 women with gestational diabetes mellitus (DM) and 196 women with pregestational DM, with particular reference to the influence of maternal obesity and excessive weight gain. These were consecutive singleton pregnancies delivered in our institution over 5 years. After controlling for multiple risk factors, including maternal BMI and pregnancy weight gain, women with pregestational DM were at increased risk (compared to those with gestational DM) for Caesarean delivery (OR 3.6, 95%CI 2.3-5.6), shoulder dystocia or cephalopelvic disproportion (OR 2.2, 95%CI 1.3-3.6), and gestational hypertension or toxaemia (OR 3.0, 95%CI 1.7-5.4). The offspring of these women were also at increased risk for admission to the neonatal intensive care unit (OR 4.0, 95%CI 2.3-6.8), large-for-gestational-age birthweight (OR 3.5, 95%CI 2.2-5.6), and preterm birth before 37 weeks (OR 3.8, 95%CI 2.5-5.9). Maternal obesity, and, to a lesser degree, excessive weight gain, were also independent risk factors for all these adverse maternal and neonatal outcomes, regardless of the type of DM, except for shoulder dystocia/cephalopelvic disproportion.
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PMID:Maternal and neonatal outcomes in pregestational and gestational diabetes mellitus, and the influence of maternal obesity and weight gain: the DEPOSIT study. Diabetes Endocrine Pregnancy Outcome Study in Toronto. 1143 30

Diabetes in pregnancy, whether the woman had diabetes prior to becoming pregnant or developed gestational diabetes, is associated with many complications and risks. In the first trimester, organogenesis can be disrupted by complications due to poor control of the mother's diabetes, leading to fetal malformations or perinatal mortality. Problems with glucose control in the remainder of the pregnancy can also have consequences for the child. These include macrosomia, shoulder dystocia, pre-eclampsia, hypoglycemia and an increased risk for obesity and diabetes in the future. Therefore, aggressive and prompt treatment of the high blood sugar levels, which cause these complications, is necessary. This review looks at the current treatments for pregnancies complicated by diabetes and evaluates the place of new and possible future treatments including diet, exercise, insulin, insulin analogs and oral and inhaled agents.
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PMID:New and future diabetes therapies: are they safe during pregnancy? 1268 46

The present study was aimed to investigate pregnancy outcome among obese women and specifically the correlation between maternal obesity and incidence of caesarean section (CS) while controlling for the potential confounding effects of other variables associated with obesity. A population-based study was performed comparing all pregnancies of obese (maternal pre-pregnancy body mass index (BMI) of 30 kg/m2 or more) and non-obese patients, between the years 1988 and 2002. Patients with hypertensive disorders and diabetes mellitus as well as patients lacking prenatal care were excluded from the analysis. Stratified analyses, using the Mantel-Haenszel technique, and a multiple logistic regression model were performed to control for confounders. During the study period there were 126,080 deliveries meeting the inclusion criteria, of which 1769 (1.4%) occurred in obese patients. Using a multivariable analysis, the following conditions were significantly associated with maternal obesity: failure to progress during the first stage (odds ratio (OR) = 3.1; 95% confidence interval [CI] 2.5, 3.8; P < 0.001), fertility treatments (OR = 2.0; [95% CI 1.6, 2.5]; P < 0.001), previous CS (OR = 1.7; [95% CI 1.5, 1.9]; P < 0.001), malpresentations (OR = 1.4; [95% CI 1.2, 1.6]; P < 0.001), recurrent miscarriages (OR = 1.4; [95% CI 1.2, 1.7]; P < 0.001) and fetal macrosomia (OR = 1.4; [95% CI 1.2, 1.7]; P < 0.001). Higher rates of caesarean deliveries were found among obese parturients (27.8% vs. 10.8%; OR = 3.2; [95% CI 2.9, 3.5]; P < 0.001). When controlling for possible confounders, using the Mantel-Haenszel technique, the association between maternal obesity and CS remained significant. No significant differences were noted between the groups regarding perinatal complications such as perinatal mortality, congenital malformations, shoulder dystocia and low Apgar scores. In conclusion, a significant association was found between obesity and CS even after the exclusion of hypertensive disorders and diabetes mellitus. Importantly, obesity alone was not associated with adverse perinatal outcome. Obstetricians should be encouraged to allow obese patients not suffering from diabetes or hypertensive disorders an adequate trial of labour.
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PMID:Maternal obesity as an independent risk factor for caesarean delivery. 1513 Jan 59


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