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

Maternal obesity has been associated with both gestational diabetes mellitus (GDM) and neonatal macrosomia. Most studies of obesity in pregnancy have demonstrated an increased risk for GDM. However, the contribution of obesity as an added risk in GDM has not been examined. The purpose of this study was to examine the contribution of obesity as a risk factor to perinatal morbidity in gestationally diabetic women by comparing the maternal and neonatal outcome in obese and nonobese gestationally diabetic women. From 1979 to 1983, the maternal, intrapartum, and neonatal characteristics of all prepartum gravid patients with GDM were examined. Of the 158 patients with documented GDM, 62 (39%) were obese (weight greater than 90 kg). There was no difference in maternal age (obese 29.3 +/- 5.4 years, nonobese 28.7 +/- 6.5 years) parity, or prepartum risk score between the obese and nonobese patients. The incidence of prematurity, pre-eclampsia, fetal distress, and primary cesarean sections were not different between the groups. There were no differences in Apgar scores, gestational age, or perinatal morbidity. However, the obese patients delivered heavier neonates expressed as mean birthweight (obese 3667 +/- 682 gms, nonobese 3331 +/- 750 gms. P less than .01), the number of macrosomic (greater than 4 kg) neonates (obese 37%, nonobese 14%, P less than .001) and K-score, (obese 0.8 +/- 1, nonobese 0.4 +/- 9, P less than .05). These data indicate that obese patients with GDM have an increased risk of neonatal macrosomia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Maternal obesity as a risk factor in gestational diabetes. 405 76

This discussion of teenage pregnancy focuses on the following: the scope of the problem; identification of the pregnant teenager; causes of teenage pregnancy (biologic factors, the role of peers, societal influences, and contraception); the teenage father; complications of pregnancy; nutrition in teenage pregnancy (protein requirements, vitamins, minerals, and trace minerals); the options for a pregnant teenager; and prevention. Of much concern is the 61% increase in the total number of births to females aged 15 and younger in the U.S. between 1960 and 1977. Teenage pregnancy is not a new problem, yet in the last 20 years several factors have influenced the awareness of the problem and its consequences. Furstenberg identifies several reasons for increased attention devoted to teen pregnancy: an increase in the teenage population; more awareness of population control; more liberal teenage sexual behavior, coupled with a disdain for early marriage, and resulting in increased illegitimate birth; and governmental concern regarding socioeconomic conditions vis-a-vis teenage parenthood and poor educational, vocational, and social stability. Experience shows that the pregnant teenager is unlikely to have completed growth tasks, particularly the acquisition of independent thinking and a mature understanding of self. There is a significant population of females aged 12.5-15 years who biologically and physically are close to being mature women and are capable of becoming pregnant. That population grows larger monthly throughout the schoolage years. Repeatedly, teenagers encountered in practice, clinics, and an outreach educational project have reported that peer pressure is their single greatest motivator in regard to sexual behavior. In the last 20 years, the concept in advertising has been sex and an attitude of acceptance toward sexuality. If society acquiesces to the constant exposure of its young people to sex, it needs to provide a support system that enables the adolescent to deal effectively with sex. Adolescents frequently deny that they can become pregnant, and consequently they fail to even consider contraception. The potential teenage father needs to be prepared by education and counseling for either appropriate delay of his role as a father or coping with its premature occurrence. It appears that with the exception of preeclampsia and a small bony pelvis in the adolescent, the majority of complications of teenage pregnancy are more a function of lack of prenatal care than they are of maternal age. Factors related to nutrition that place the adolescent at risk during pregnancy include low prepregnancy weight, insufficient weight gain, obesity, existing medical complications, dietary faddism, pica, and low income or ethnic variances.
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PMID:Teenage pregnancy. 704 65

This is the first report of the largest study of blood pressure measurement in pregnancy in a New Zealand population using standardized definitions and methodology. Over 3,800 women who delivered in an 8-month period in the Wellington region were included in the study. Blood pressure measurement and the presence of oedema and proteinuria were recorded from booking until delivery and in the puerperium. Only 2.7% of women were unable to be contacted after delivery for details on outcomes. The results established normal ranges for blood pressure throughout pregnancy. The data show that blood pressure greater than 140/90 until 35 weeks' gestation is outside 2 standard deviations at all gestations and justifies using these measurements as the definition of hypertension in pregnancy. The fall in blood pressure in the 2nd trimester was less than 1 mm Hg per week in both the systolic and diastolic pressures. This fall was smaller than previously recorded in other studies. Gestational hypertension was the commonest blood pressure abnormality occurring in 15.2% of the population. This represented 69% of the pregnant women with a hypertensive disorder. The overall incidence of both gestational hypertension and preeclampsia was 18.5% which is higher than reported in other parts of the world. In this study obesity was significantly associated with hypertensive disorders in pregnancy. An arm circumference of > 33 cm, one of the measurements of obesity, was found in 6.8% of the study population. Even after the effect of arm circumference was taken into account, hypertensive disorders were also more common in Pacific Island women.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Measurements of blood pressure, oedema and proteinuria in a pregnant population of New Zealand. 777 96

Several large family studies are reviewed to identify results suggesting single gene traits contributing to the occurrence of hypertension in humans. Segregation analysis in families has suggested major gene effects for several highly heritable traits associated with hypertension. These include recessively segregating high sodium-lithium countertransport (major gene H2 = 34%), additively segregating low urinary kallikrein excretion (major gene H2 = 51%), and recessively segregating hyperinsulinemia (major gene H2 = 33%). In some families, hypertension and metabolic abnormalities (dyslipidemia, hyperinsulinemia, and obesity) seem to be related to several candidate genes studied but not conclusively proven (LPL deficiency mutations, dense LDL subfractions, or NIDDM with hyperinsulinemia). More recently, DNA markers have identified genes promoting hypertension. Glucocorticoid-remediable aldosteronism (GRA) promotes a rare but unusual form of hypertension that is unresponsive to ordinary medications but very responsive to glucocorticoid medications. GRA has been found in hypertensive persons with a specific mutation of the 11 beta-hydroxylase gene on chromosome 8q21. Many persons with essential hypertension carry a common "susceptibility gene" at the angiotensinogen locus (chromosome 1q4) identified using linkage studies in siblings, association studies, and in studies of preeclampsia and hypertension in pregnant women. These first two well-established genetic loci promoting human hypertension represent two ends of a broad spectrum. The rare "determinant" gene for GRA by itself seems to produce severe hypertension and early strokes. The angiotensinogen (AGT) "susceptibility" gene is very common (30% of Utah Caucasians) and seems to predispose to hypertension but probably requires other genetic and environmental influences to be fully expressed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Evidence for single gene contributions to hypertension and lipid disturbances: definition, genetics, and clinical significance. 798 84

The hemorheological properties of women with obesity were studied during pregnancy. Blood viscosity at a shear rate of 0.5/sec was measured with a Contraves Low Shear 100 viscometer and that at a shear rate of 115/sec was measured with a Well-Brookfield viscometer. The levels of blood viscosity (both shear rates) of non-pregnant and pregnant women with obesity were significantly higher compared than those of control women. Plasma viscosity was similar in both groups. The filterability of erythrocytes was determined with a St. George's Filtrometer. The initial relative filtration rate, which represented the deformability of each red cell, was similar in both groups. The clogging rate which represented the properties of red clogging capillaries was increased in non-pregnant women with obesity as compared in non-pregnant control women. However, it was similar in pregnant women in both groups. Hematocrits were increased significantly in women with obesity both in non-pregnant and pregnant states. There was no significant difference between fibrinogen levels in the two groups. The results of the present study suggested that the high frequency of pre-eclampsia among pregnant women with obesity was due to increased Ht and blood viscosity which were factors predisposing to pre-eclampsia.
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PMID:[A study on hemorheology of pregnant women with obesity]. 831 16

The purpose of this study was to determine which patient and pregnancy characteristics in the first pregnancy complicated by gestational diabetes mellitus (GDM) were associated with the diagnosis of GDM before 24 weeks' gestation in a subsequent pregnancy--early recurrent GDM. The case notes of 180 women who previously had GDM diagnosed and who had glucose tolerance tests performed before 24 weeks' gestation in their next ongoing pregnancy were reviewed. Factors examined included severity of GDM, insulin requirement, racial origin, macrosomia, obesity, age, family history of diabetes, preeclampsia, and parity. Multivariate analysis showed that women with early recurrent GDM were more likely, in their first pregnancy with GDM, to have needed insulin (odds ratio [OR] 11.26; 95% confidence interval [CI] 2.02 to 62.65), to be more often of non-Northern European origin (OR, 5.53; 95% CI, 2.46 to 12.44), to have had a macrosomic infant (OR, 4.01; 95% CI, 1.40 to 11.49) or severe GDM (OR, 3.52; 95% CI, 1.60 to 7.76), and were more often 30 years or more of age (OR, 2.27; 95% CI, 1.05 to 4.90). Obesity, family history, fasting plasma glucose levels, and parity were not significant risk factors. However, even without any of the significant risk factors, logistic regression modeling suggested that a woman who has had GDM in a previous pregnancy has a 5.1% (95% CI, 2.2 to 11.6%) chance of having early recurrent GDM. We therefore continue to recommend that all women who have had GDM diagnosed previously should have glucose tolerance testing performed early (before 24 weeks' gestation) in any future pregnancies.
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PMID:Factors predictive of recurrent gestational diabetes diagnosed before 24 weeks' gestation. 854 Sep 42

Most cases of postpartum haemorrhage are caused by uterine atony, maternal soft-tissue trauma, retained placenta or its parts, and obstetric coagulopathy. The factors most significantly associated with haemorrhage include advanced maternal age, prolonged labour, pre-eclampsia, obesity of mother, multiple pregnancy, a birth weight of more than 4000g, and previous postpartum haemorrhage. It seems that multiparity itself is only a weakly associated factor. The prophylactic use of oxytocic drugs (oxytocin or its combination with ergometrine at the third stage of labour is always recommended for decreasing the bleeding. Prostaglandins should be used as a second line treatment if uterine atony cannot be abolished by uterine massage and oxytocin infusion. In the surgical management, the role of hypogastric artery ligation is decreasing. The stepwise uterine devascularization may be a reasonable method in the most severe uncontrollable postpartum bleeding. The uterine tamponade with gauze or specific tubes may also be a useful alternative in some cases. Selective arterial embolization is a promising new method that seems to have success in controlling the heavy postpartum bleeding unresponsive to more usual measures. However, the value of this method should be evaluated in bigger series.
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PMID:Postpartum haemorrhage. 862 78

The purpose of the present study was to examine the relationship between severe pre-eclampsia/eclampsia (toxaemia) and obesity. We collected sociodemographic, anthropometric, medical and pregnancy outcome data from the hospital records of 248 Israeli women diagnosed with either pregnancy-induced or chronic hypertension, and compared these data to a control group of 236 women. Univariate analysis showed that while there exists a statistically significant positive association between obesity and hypertension (both pregnancy-induced and chronic) obesity presents no added risk to the development of toxaemia. Furthermore, we found a significant decrease in the rate of obesity among primigravid versus multigravid mothers with toxaemia superimposed on pregnancy-induced hypertension. On the other hand, primigravid mothers with PIH were at an increased risk of developing toxaemia as compared to multigravid women. These results suggest that obesity is not a significant factor in the development of toxaemia.
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PMID:Obesity and the risk of toxaemia of pregnancy. 888 43

Twelve Caesarean section-associated maternal deaths were encountered over a 15-year period. The major operative risk factors were pregnancy-induced hypertension, obesity and general anaesthesia. Severe preeclampsia was the forerunner to postoperative cardiac failure, consumptive coagulopathy and difficult airway manipulation. We conclude that pregnancy-induced hypertension and its ramifications pose the greatest threat to maternal survival from a Caesarean section.
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PMID:Maternal deaths associated with caesarean section. 903 30

The pregnancy syndrome preeclampsia is associated with placental dysfunction, dyslipidemia, and endothelial cell activation, and is a major cause of maternal and fetal morbidity and mortality. In this report, a nested case-control study of matched preeclamptic and normal pregnant women was used to investigate the association of maternal and fetal modulators of lipid metabolism with pregnancy outcome. Maternal body mass index (BMI), triglyceride levels, and nonesterified fatty acid (NEFA) concentrations were all significantly increased in women who developed preeclampsia (P < .01). Human placental lactogen (hPL), which is secreted by the syncytiotrophoblast layer of the fetal placenta and reportedly has lipolytic activity, also was found to be elevated in women with preeclampsia (P < .01). By contrast, hemoglobin levels were not found to be statistically different between the two groups of women, indicating that the increased plasma lipids and hPL were not a result of hemoconcentration in preeclamptic patients. The results suggest a multihit hypothesis for the pathophysiology of preeclampsia in which maternal obesity and a placental lipolytic hormone (hPL) converge to adversely affect free fatty acid concentrations in the maternal circulation.
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PMID:Maternal and fetal modulators of lipid metabolism correlate with the development of preeclampsia. 925 83


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