Birth and Delivery · Birth Outcomes
Abstract
Introduction
Pregnancy and delivery in case of overweight women require special care. The main means of preventing obstetrical complications is promoting healthy lifestyle and pregnancy weight gain control among females planning the pregnancy as well as prenatal diagnosis and pregnancy/delivery course monitoring.
Objectives
The aim of the study was to evaluate the pregnancy and delivery course in overweight and obese pregnant women.
Materials and Methods
The study was based on a retrospective analysis of medical files of 132 pregnant women delivering in Gynecology and Obstetrics Clinic in Tychy, Poland. The investigated group was divided into subgroups based on pre-pregnancy body mass index according to World Health Organization Criteria for obesity. The comparative analysis was then performed between the subgroups.
Results
The prevalence of bleedings in pregnancy pregnancy induced hypertension, diabetes and urinary tract infections was statistically higher in obese pregnant females. Similarly the rate of shoulder dystocia was statistically higher in the obese and overweight subgroups of women. There were no significant differences between subgroups in mean neonate body length or mean Apgar scores. However the highest neonate body weight was observer in subgroup of overweight females and those with pre-pregnancy normal BMI who gained more than 16 kilograms during pregnancy.
Conclusions
1. Excessive weight gain in pregnancy is associated with higher risk of pregnancy and delivery complications. 2. Both excessive pre-pregnancy body weight and excessive weight gain in pregnancy increase the risk of perinatal complications.
Topics
By this author
Prescribing Safety · Off-Label Prescribing
Recombinant activated factor VII administration in a patient with congenital lack of factor VII undergoing laparoscopic hysterectomy: A case report
Dąbrowski FA et al., 2021 · International journal of surgery case reports · Free full text on PubMed Central
Case report of patient with congenital lack of factor VII, suffering from recurrent hematomas and massive menstrual bleedings resulting in severe anemia and multiple hospitalization. Patient was diagnosed with endometrial hyperplasia and not responding to hormonal treatment and substitution with recombinant factor VII was not effective to reduce the bleedings. This case describes successful laparoscopic technique of using bipolar coagulation and non-absorbable clips. We describe premedication and post-surgical management - which we had to modify from this found in very scarce literature. Despite previous vaginal deliveries without any complications during the puerperium, 20 days after the surgery patient presented with intraperitoneal bleeding after stopping rFVIIa therapy. It was treated medically without the need for re-laparoscopy. Laparoscopic surgery is possible in patients with lack and deficiency of FVIIa, but they need close post-operative surveillance and prolonged supplementation with recombinant FVIIa.
Infections · Vaginal and Cervical Infections
Streptococcus group B serotype distribution in anovaginal isolates of women in term pregnancy
Romanik M et al., 2014 · Neuro endocrinology letters
To evaluate Streptococcus group B (GBS) serotype distribution in anovaginal isolates of women in term pregnancy and to assess the correlation of the distribution with socio-epidemiological variables and neonatal outcomes. An observational study. Department of Gynecology and Obstetrics, Specialist Teaching Hospital in Tychy, Poland. 80 women between 37 and 40 gestation weeks with preserved fetal membranes and who had not been treated with antibiotics for at least two weeks before the study. The specimens from the vagina and the rectum of pregnant women were collected. GBS colonization tests were conducted in compliance with Centers for Disease Control and Prevention recommendations. Serotyping of the isolates was performed using the Essum GBS Serotyping Kit (Umea, Sweden) according to manufacturer's instruction. Mein outcome measures. GBS serotype distribution in the population of Polish women in term pregnancy. In the studied group of 80 pregnant women GBS colonization rate was 28.7%. Four GBS serotypes were observed (Ia, V, III and II). Serotype Ia was the most predominant - 43.47%. For GBS Ia, V and III serotypes, no significant difference in the prevalence of diabetes mellitus and neonatal outcomes was observed. Only in one case early-onset sepsis was diagnosed in the neonate and serotype Ia was determined. 1) From among four identified GBS serotypes in the population of Polish pregnant women, serotype Ia was the most dominant. 2) For GBS serotypes, no significant difference in the prevalence of diabetes mellitus and neonatal outcomes was observed. 3) Active immunization aimed for preventing GBS colonization in mothers should include not only serotypes V, II and III but also Ia in order to be an effective and safe in preventing life threatening neonatal infections.
Screening and Prevention · Cervical Cancer Screening
[Awareness of cervical cancer prevention among patients of gynecological outpatient clinic]
Ulman-Włodarz I et al., 2011 · Ginekologia polska
Improvement of cervical cancer statistics in Poland is believed to be one of the main goals of all medical services. Cervical cancer is an easily preventable neoplasm thus effective strategies for its prophylaxis should be proposed and introduced to the whole population of Polish citizens. The aim of the study was to measure the extent of knowledge of females about cervical cancer and its prevention. 250 female patients of gynecological clinic at the Medical Centre in Krakow, Poland, aged 18-60, were included into the retrospective study The research was based on an original questionnaire designed by the authors containing questions concerning general socio-epidemiological status, as well as cervical cancer epidemiology and HPV infection prevention methods. The majority of respondents (68%) rated their knowledge on cervical cancer prevention strategies as medium. The main sources of information on that prophylaxis were: women's magazines (59% of respondents), media (47%) and Internet (38%). Additionally only one in three women acquired that information from gynecologist The main reason for performing the Pap smear test was the request of the respondent (43% of cases). Only 3% of them attended the test as a result of a personal invitation sent by National Health Service. The main reasons for not attending Pap smear test were: fear of pain (39%), lack of any symptoms (18%), carelessness (15%) and embarrassment (12%). 1. Knowledge on HPV infections and cervical cancer prevention among women attending gynecological outpatient clinic is insufficient. 2. Education, especially in the field of cervical cancer main risk factors as well as the course of pap smear collection, seems to be necessary in order to reduce the cervical cancer morbidity and the fear of performing pap smear tests.
Hormonal Agents · Gonadotropins
[Influence of GnRH analogue on the intensification of endometriosis symptoms and infertility treatment]
Skrzypulec V et al., 2004 · Wiadomosci lekarskie (Warsaw, Poland : 1960)
The aim of this study was to evaluate the influence of the treatment with oral doses of 50 mg GnRH analogue on the intensification of endometriosis symptoms and infertility amongst women with evident symptoms of endometriosis in comparison with placebo group. A group of 34 women at the age from 18 to 45 were introduced into the study. The inclusion criteria for investigated population contained: endometriosis symptoms, endometriosis diagnosed by laparoscopy, its surgical or pharmacological treatment, negative pregnancy test score and regular menses. The patients were divided into 2 groups: investigated group and control group. Women completed "Diary" every day in which they estimated main endometriosis symptoms: dysmenorrhea, dyspareunia, pelvic pain and vaginal bleeding (according to Pain Grading Scale). The intensification of dysmenorrhea and vaginal bleeding was reduced in the investigated group in comparison with control one. These differences were statistically significant. Although the extremity of dyspareunia was decreased in two groups, this correlation was statistically significant only in the investigated group. Pelvic pain evaluation showed that its level was lower in the investigated group (p > 0.05). It was found that 11 women (investigated group) and 5 women (control group) got pregnant after the period of 12-week treatment. GnRH analogues have an efficient influence on the reduction of endometriosis symptoms. GnRH analogues could be used in the management of infertility.
Related research
Birth Outcomes · Maternal Morbidity
Obesity, obstetric complications and cesarean delivery rate--a population-based screening study
Weiss JL et al., 2004 · American journal of obstetrics and gynecology
This study was undertaken to determine whether obesity is associated with obstetric complications and cesarean delivery. A large prospective multicenter database was studied. Subjects were divided into 3 groups: body mass index (BMI) less than 30 (control), 30 to 34.9 (obese), and 35 or greater (morbidly obese). Groups were compared by using univariate and multivariable logistic regression analyses. The study included 16,102 3,752 control, 1,473 obese, and 877 morbidly obese patients. Obesity and morbid obesity had a statistically significant association with gestational hypertension (odds ratios [ORs] 2.5 and 3.2), preeclampsia (ORs 1.6 and 3.3), gestational diabetes (ORs 2.6 and 4.0), and fetal birth weight greater than 4000 g (ORs 1.7 and 1.9) and greater than 4500 g (ORs 2.0 and 2.4). For nulliparous patients, the cesarean delivery rate was 20.7% for the control group, 33.8% for obese, and 47.4% for morbidly obese patients. Obesity is an independent risk factor for adverse obstetric outcome and is significantly associated with an increased cesarean delivery rate.
Birth Outcomes · Maternal Morbidity
Obesity in pregnancy: risks and management
Fitzsimons KJ et al., 2009 · Obstetric medicine · Free full text on PubMed Central
Maternal obesity is now considered one of the most commonly occurring risk factors seen in obstetric practice. Compared with women with a healthy pre-pregnancy weight, women with obesity are at increased risk of miscarriage, gestational diabetes, preeclampsia, venous thromboembolism, induced labour, caesarean section, anaesthetic complications and wound infections, and they are less likely to initiate or maintain breastfeeding. Babies of obese mothers are at increased risk of stillbirth, congenital anomalies, prematurity, macrosomia and neonatal death. Intrauterine exposure to obesity is also associated with an increased risk of developing obesity and metabolic disorders in childhood. This article reviews the prevalence of obesity in pregnancy and the associated maternal and fetal complications. Recommendations and suggestions for pre-conception, antenatal and postnatal care of women with obesity are presented, and current research in the UK and future research priorities are considered.
Thyroid and Metabolic Function · Insulin and Metabolism
Pregnancy in infertile PCOD patients. Complications and outcome
Urman B et al., 1997 · J Reprod Med
To evaluate the complications and outcome of pregnancy in women with polycystic ovary disease (PCOD). The course and outcome of 47 singleton pregnancies in women with well-documented PCOD were compared with those in 100 healthy controls. Women with PCOD had a significantly higher body mass index as compared to the control group (P < .05); however, the proportion of lean versus obese subjects in the two groups was similar. The incidence of an abnormal glucose challenge test, gestational diabetes mellitus and pregnancy-induced hypertension was significantly increased in pregnant women with PCOD (P < .05). When lean PCOD subjects were compared with lean control subjects, the difference in the incidence of the above complications was still significant (P < .05). The incidence of pregnancy complications was similar when obese PCOD subjects were compared with obese controls. Women with PCOD were at increased risk of gestational diabetes and pregnancy-induced hypertension, and this risk appeared to be independent of body mass index.
Nutrition and Metabolic Health · Body Weight and Composition
An internet-based prospective study of body size and time-to-pregnancy
Wise LA et al., 2009 · Hum Reprod · Free full text on PubMed Central
Recent studies have shown that both female and male obesity may delay time-to-pregnancy (TTP). Little is known about central adiposity or weight gain and fecundability in women. We examined the association between anthropometric factors and TTP among 1651 Danish women participating in an internet-based prospective cohort study of pregnancy planners (2007-2008). We categorized body mass index (BMI = kg/m(2)) as underweight (<20), normal weight (20-24), overweight (25-29), obese (30-34) and very obese (> or =35). We used discrete-time Cox regression to estimate fecundability ratios (FRs) and 95% confidence intervals (CI), controlling for potential confounders. We found longer TTPs for overweight (FR = 0.83, 95% CI = 0.70-1.00), obese (FR = 0.75, 95% CI = 0.58-0.97), and very obese (FR = 0.61, 95% CI = 0.42-0.88) women, compared with normal weight women. After further control for waist circumference, FRs for overweight, obese, and very obese women were 0.72 (95% CI = 0.58-0.90), 0.60 (95% CI = 0.42-0.85) and 0.48 (95% CI = 0.31-0.74), respectively. Underweight was associated with reduced fecundability among nulliparous women (FR = 0.82, 95% CI = 0.63-1.06) and increased fecundability among parous women (FR = 1.61, 95% CI = 1.08-2.39). Male BMI was not materially associated with TTP after control for female BMI. Compared with women who maintained a stable weight since age 17 (-5 to 4 kg), women who gained > or =15 kg had longer TTPs (FR = 0.72, 95% CI = 0.59-0.88) after adjustment for BMI at age 17. Associations of waist circumference and waist-to-hip ratio with TTP depended on adjustment for female null associations were observed before adjustment for BMI and weakly positive associations were observed after adjustment for BMI. Our results confirm previous studies showing reduced fertility in overweight and obese women. The association between underweight and fecundability varied by parity.
Birth and Delivery › Birth Outcomes › Maternal Morbidity · Pregnancy › Pregnancy Complications › Hypertensive Disorders
Izabela Ulman-Włodarz, Krzysztof Nowosielski, Małgorzata Romanik, Janusz Pozowski, Patrycja Krawczyk
I Ulman-Włodarz, K Nowosielski, M Romanik, J Pozowski, P Krawczyk
PMID 19943538 19943538 Ulman-Włodarz et al. 2009, Ulman-Włodarz 2009