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

Obesity is becoming an epidemic worldwide. Among young women, obesity is especially important because maternal obesity confers an increased risk of preeclampsia, a hypertensive disorder of pregnancy and a leading cause of maternal and fetal morbidity and mortality. It is not known why obesity is a risk factor for preeclampsia, but these conditions might be related through common features related to oxidative stress, inflammation and altered vascular function. Recently, extensive vascular infiltration of neutrophils and vascular inflammation has been reported in both preeclamptic women and obese women. Therefore, if the vasculature of obese women is inflamed, they could be at increased risk of developing preeclampsia when they become pregnant and are exposed to the additional burdens of pregnancy.
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PMID:Obesity: a risk factor for preeclampsia. 1802 57

Epidemiological data indicate that women with preeclampsia are more likely to develop cardiovascular disease (CVD) later in life. Population-based studies relate preeclampsia to an increased risk of later chronic hypertension (RR, 2.00 to 8.00) and cardiovascular morbidity/mortality (RR, 1.3 to 3.07), compared with normotensive pregnancy. Women who develop preeclampsia before 36 weeks of gestation or have multiple hypertensive pregnancies are at highest risk (RR, 3.4 to 8.12). The underlying mechanism for the remote effects of preeclampsia is complex and probably multifactorial. Many risk factors are shared by CVD and preeclampsia, including endothelial dysfunction, obesity, hypertension, hyperglycemia, insulin resistance, and dyslipidemia. Therefore, it has been proposed that the metabolic syndrome may be a possible underlying mechanism common to CVD and preeclampsia. Follow-up and counseling of women with a history of preeclampsia may offer a window of opportunity for prevention of future disease.
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PMID:Preeclampsia: at risk for remote cardiovascular disease. 1803 Jan 86

This chapter concerning maternal mortality due to anaesthesia, reprinted with permission from Saving Mothers' Lives, is the 18th in a series of reports within the Confidential Enquiries into Maternal and Child Health (CEMACH) in the UK. In the years 2003-05 there were six women who died from problems directly related to anaesthesia, which is the same as the 2000-02 triennium. Obesity was a factor in four of these women who died. Two of these deaths were in women in early pregnancy, who received general anaesthesia for gynaecological surgery by inexperienced anaesthetists who failed to manage the airway and ventilation adequately. When trainee anaesthetists are relatively inexperienced their consultants must know the limits of their competence and when close supervision and help may be needed. One death was due to bupivacaine toxicity due to a drug administration error when a bag of dilute local anaesthetic was thought to be intravenous fluid. In a further 31 cases poor perioperative management may have contributed to death. Obesity was again a relevant factor. Other cases could be categorized into poor recognition of women being sick and poor clinical management of haemorrhage, sepsis and of pre-eclampsia. Early warning scores of vital signs may help identify the mother who is seriously ill. Learning points are highlighted in relation to the clinical management of these obstetric complications.
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PMID:Anaesthesia chapter from Saving mothers' lives; reviewing maternal deaths to make pregnancy safer. 1834 76

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. There is an increasing body of evidence indicating that PCOS may have significant implications for pregnancy outcomes and long-term health of a woman and her offspring. Whether or not PCOS itself or the symptoms that coincide with PCOS, like obesity and fertility treatment, are responsible for these increased risks is a continuing matter of debate. Miscarriage rates among women with PCOS are believed to be increased compared with normal fertile women, although supporting evidence is limited. Pregnant women with PCOS experience a higher incidence of perinatal morbidity from gestational diabetes, pregnancy-induced hypertension, and preeclampsia. Their babies are at an increased risk of neonatal complications, such as preterm birth and admission at a neonatal intensive care unit. Pre-pregnancy, antenatal, and intrapartum care should be aimed at reducing these risks. The use of insulin sensitizing drugs to decrease hyperinsulinemic insulin resistance has been proposed during pregnancy to reduce the risk of developing preeclampsia or gestational diabetes. Although metformin appears to be safe, there are too few data from prospective, randomized controlled trials to support treatment during pregnancy.
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PMID:Pregnancy complications in women with polycystic ovary syndrome. 1818 Oct 85

Obesity is reaching pandemic proportions worldwide. It is increasingly being recognised as a risk factor during pregnancy. Women should ideally be counselled preconceptionally about the increased risks and encouraged to lose weight actively, some may be candidates for bariatric surgery. Maternal risks include gestational diabetes, hypertension and pre-eclampsia, increased incidence of operative delivery, postpartum haemorrhage, anaesthetic risks as well as infective and thrombo-embolic complications while fetal risks include miscarriage, neural-tube defects, macrosomia and stillbirth. Obstetric units should institute appropriate guidelines for the management of pregnancy in this 'high-risk' group of women.
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PMID:Obesity and pregnancy. 1825 92

Magnesium plays a role in a number of chronic, disease-related conditions. This article reviews current pertinent literature on magnesium, focusing on hypertension and cardiovascular diseases and implications for relationships with diabetes and metabolic syndrome. A major role for magnesium is in the regulation of blood pressure. While data are not entirely consistent, it does appear that an inverse relationship between magnesium intake and blood pressure is strongest for magnesium obtained from food rather than that obtained via supplements. Hypertension associated with preeclampsia appears to be alleviated when magnesium is administered; in addition, women with adequate intakes of magnesium are less likely to be affected by preeclampsia than those with an inadequate intake. A role for magnesium in other cardiovascular diseases has been noted in that increased magnesium intake may improve serum lipid profiles. Dietary magnesium is also recommended to aid in the prevention of stroke and is important for skeletal growth and development. Magnesium may also play a role in the development of diabetes mellitus, obesity, and metabolic syndrome. There are data from some studies, such as the DASH and PREMIER studies, that suggest that lifestyle changes (including adequate magnesium intake) can benefit blood pressure control, promote weight loss, and improve chronic disease risk.
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PMID:Magnesium in hypertension, cardiovascular disease, metabolic syndrome, and other conditions: a review. 1839 Jul 81

Our understanding of cerebral palsy (CP) in term infants is hindered by its low incidence and sporadic presentation. Many of these CP cases enter litigation, and a focused review of medicolegal consultations provides an opportunity to better understand the pathogenesis of these cases. In this study complete clinical and pathologic data from 158 cases of CP complicating singleton pregnancies after 36 weeks of gestation were prospectively collected over a 10-year period extending from 1998 to 2008. A hierarchical system was used to separate cases into the following 5 groups: (1) clinical/sentinel events (20%), (2) severe large fetoplacental vascular lesions (34%), (3) placental lesions indicative of chronic placental dysfunction (23%), and (4) placental lesions indicative of subacute/chronic adaptation to hypoxia (15%). The remaining 8% (group 5) of cases were idiopathic. Common to all subgroups was clinical and/or pathologic evidence of umbilical cord obstruction, which was observed in 63% of cases. The following clinical features significantly differed among subgroups. Group 1 had less maternal obesity and more cases involving multicystic encephalopathy. Group 2 had increased oligohydramnios, cerebral edema, nucleated red blood cell counts greater than 10 000/mm(3), hypoglycemia, pulmonary hypertension, and cardiac dysfunction. Group 3 had more preeclampsia and, together with group 2, more infants with a low ponderal index. Group 5 had a higher prevalence of positive family history of neurodevelopmental disorders. In conclusion, infant cases subject to litigation related to CP following term birth can be separated into distinct clinicopathologic subgroups with only a small number lacking either clinical/sentinel events or placental evidence of subacute or chronic in utero stress.
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PMID:Cerebral palsy in term infants: a clinicopathologic analysis of 158 medicolegal case reviews. 1854 9

Cigarette smoking protects against preeclampsia but increases the risk of small-for-gestational-age birth (SGA). Regarding body weight, the converse is true: obesity elevates rates of preeclampsia but reduces rates of SGA. The authors assessed the combined effects of smoking and weight among US women developing preeclampsia or SGA, studying 7,757 healthy, primigravid women with singleton pregnancies in 1959-1965. Smoking (never, light, heavy), stratified by prepregnancy body mass index (BMI (weight (kg)/height (m)(2)); underweight, overweight, obese), was examined in relation to preeclampsia and SGA. Among underweight (BMI <18.5) and normal-weight (BMI 18.5-24.9) women, smoking decreased the risk of preeclampsia (for heavy smoking, light smoking, nonsmoking, test for trend p = 0.002 for underweight and p = 0.009 for normal weight) after adjustment for age, race, and socioeconomic status. However, among overweight/obese women (BMI >or=25), this trend was not apparent (p = 0.4). Among both underweight and overweight women, smoking significantly increased SGA risk (trend p < 0.001 for underweight and p = 0.02 for overweight/obese). Obesity eliminated the inverse association between smoking and preeclampsia but did not substantially alter the positive association between smoking and SGA. A possible unifying biologic explanation is discussed in this paper.
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PMID:Interactions between smoking and weight in pregnancies complicated by preeclampsia and small-for-gestational-age birth. 1855 61

Several studies suggest that women with previous preeclampsia (PE) are at increased risk of cardiovascular disease (CVD). We examined circulating concentrations of adhesion molecules and C-reactive protein (CRP), markers for endothelial and inflammatory reactions, in addition to blood pressure and anthropometric measurements in 58 women with a history of PE and 49 control women with no pathology associated to pregnancy. Soluble adhesion molecules were measured by standard commercial ELISA methods and plasma CRP levels by automated enzymatic assays. Systolic and diastolic blood pressures and waist-to-hip ratios were significantly higher in women with history of PE than in control group. There were no significant differences in circulating levels of sICAM-1, sVCAM-1 and CRP in the study population. Women with a history of PE do not have a persistent inflammatory state that could induce overexpression of these molecules, which was supported by normal levels of CRP. The study supports the existence of common risk factors for PE and CVD, namely obesity and hypertension.
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PMID:Adhesion molecules (VCAM-1 and ICAM-1) and C-reactive protein in women with history of preeclampsia. 1872 45

A high body weight on conception and during pregnancy can have health implications for both the mother and child. Obese mothers have an increased risk of developing gestational diabetes, pre-eclampsia, delivering via Caesarean section and giving birth to large-for-gestational-age infants or infants with congenital anomalies. Women need to be educated about the importance of achieving a healthy body weight before conception, to avoid complications during pregnancy and prevent perinatal perturbations.
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PMID:Implications of high maternal weight during pregnancy. 1876 49


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