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Risks Associated with Obesity in Pregnancy, for the Mother and Baby

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (31 December 2020) | Viewed by 30544

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Special Issue Editor

Prof. Dr. Grzegorz Jakiel

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Guest Editor

1st Obstetrical and Gynaecology Department, The Center of Postgraduate Medical Education, Warsaw, Poland
Interests: pregnancy; menopausal medicine;obstetrics;perinatology;gynecological endocrinology;andrology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Obesity is a social illness of increasing frequency, which leads to a series of other diseases. The prevalence of obesity began to increase in the last decades of the 20th century in developed countries. From 1999 to 2010, obesity increased from 28.4% to 34.0% in women of reproductive age (20–39 years) in the United States.

It is known that obesity is a risk factor for mother and her child. Metabolically, obese women have increased insulin resistance in early pregnancy, which becomes manifest clinically in late gestation as glucose intolerance and fetal overgrowth. At term, the risk of cesarean delivery and wound complications is increased. Postpartum, obese women have an increased risk of venous thromboembolism, depression, and difficulty with breast feeding.

The Special Issue will focus on:

Clinical aspects regarding the course of pregnancy and perinatological outcomes; such as the risk of pregnancy induced hypertension, preeclampsia, gestational diabetes, fetal growth disorders, the risk of surgical births, length of stay in a maternity unit, and widely understood complications of delivery. Epidemiological findings are also of interest, as well as changes detected using advanced diagnostic techniques used in perinatology.
Epigenetic and molecular changes in the placenta arising from obesity, determining the clinical consequences for the fetus and then infant—both long and short term.
Neonatal consequences of obesity.
Sexual and social aspects concerning pregnant obese women.

Dr. Grzegorz Jakiel
Guest Editor

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Keywords

pregnancy outcome for mother and child
obesity
placenta
sexuality
social condition
long time consequences
genetic
epigenetic
molecular mechanisms

Published Papers (10 papers)

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Research

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16 pages, 696 KiB

Open AccessArticle

Effect of Excessive Body Weight and Emotional Disorders on the Course of Pregnancy and Well-Being of a Newborn before and during COVID-19 Pandemic

by Artur Wdowiak, Marta Makara-Studzińska, Dorota Raczkiewicz, Paula Janczyk, Aneta Słabuszewska-Jóźwiak, Anita Wdowiak-Filip and Noemi Studzińska

J. Clin. Med. 2021, 10(4), 656; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10040656 - 09 Feb 2021

Cited by 4 | Viewed by 2593

Abstract

This study aimed to evaluate whether excessive body weight and the COVID-19 pandemic affect depression, and subsequently whether depression, excessive body weight, and the COVID-19 pandemic affect the course of pregnancy, as well as the well-being of a newborn. The research material included data retrieved from the medical records of 280 pregnant women who were provided with care by medical facilities in Lublin (100 women with normal weight, 100 overweight women, 50 with Class I and 30 with Class II obesity). They completed a Beck depression inventory (BDI) in pregnancy twice, in order to assess the risk of occurrence of postpartum depression. Pre-pregnancy BMI positively correlated with the severity of depression, both at 10–13 weeks of pregnancy (p < 0.001), and at 32 weeks of pregnancy (p < 0.001). The higher the pre-pregnancy BMI, on average the higher the severity of depression. The severity of depression was significantly higher during the pandemic than before it in women with normal body weight before pregnancy (p < 0.001), as well as in those overweight (p < 0.001) and with Class II obesity (p = 0.015). Excessive body weight before pregnancy leads to depressive disorders during pregnancy, increases the risk of preterm delivery, and exerts a negative effect on the state of a newborn. Depressive symptoms among pregnant, overweight and obese women intensified during the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Risks Associated with Obesity in Pregnancy, for the Mother and Baby)

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12 pages, 2233 KiB

Open AccessArticle

Contributing Factors to Perinatal Outcome in Pregnancies with Gestational Diabetes—What Matters Most? A Retrospective Analysis

by Friederike Weschenfelder, Friederike Hein, Thomas Lehmann, Ekkehard Schleußner and Tanja Groten

J. Clin. Med. 2021, 10(2), 348; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10020348 - 18 Jan 2021

Cited by 9 | Viewed by 2210

Abstract

The aim of diabetes care of pregnant women with gestational diabetes mellitus (GDM) is to attain pregnancy outcomes including rates of large-for-gestational-age (LGA) newborns, pre-eclampsia, C-sections (CS) and other neonatal outcomes similar to those of the non-GDM pregnant population. Obesity and excessive weight gain during pregnancy have been shown to also impact perinatal outcome. Since GDM is frequently associated with elevated body mass index (BMI), we evaluated the impact of maternal prepregnancy BMI, development of GDM and gestational weight gain (GWG) during pregnancy on perinatal outcome. We compared 614 GDM patients with 5175 non-diabetic term deliveries who gave birth between 2012 and 2016. Multivariate regression analysis was used to evaluate the independent contribution of each factor on selected perinatal outcome variables. Additionally, subgroup analysis for obese (BMI ≥ 30 kg/m²) and non-obese women (BMI < 30 kg/m²) was performed. LGA was significantly influenced by BMI, GWG and GDM, while Neonatal Intensive Care Unit (NICU) admission was solely impacted by GDM. Maternal outcomes were not dependent on GDM but on GWG and prepregnancy BMI. These results remained significant in the non-obese subgroup only. Thus, GDM still affects perinatal outcomes and requires further improvement in diabetic care and patient counseling. Full article

(This article belongs to the Special Issue Risks Associated with Obesity in Pregnancy, for the Mother and Baby)

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12 pages, 675 KiB

Open AccessArticle

Excessive Gestational Weight Gain: Long-Term Consequences for the Child

by Joanna Baran, Aneta Weres, Ewelina Czenczek-Lewandowska, Justyna Leszczak, Katarzyna Kalandyk-Osinko, Edyta Łuszczki, Grzegorz Sobek and Artur Mazur

J. Clin. Med. 2020, 9(12), 3795; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9123795 - 24 Nov 2020

Cited by 16 | Viewed by 2028

Abstract

Background: The aim of the study was to analyse the impact of mothers’ gestational weight gain (GWG) and age at birth on the long-term risk of overweight and obesity in preschool and school-aged children. Methods: The study involved 749 mothers and children at ages between four and 15 years old. Each child was assessed for height and body weight, and then, the body mass category was determined based on the body mass index (BMI) percentile according to the sex and age of the subjects. Information on the perinatal risk factors for overweight and obesity came from the child’s health card or mother’s maternity card. They contained information about the mother’s age at the time of childbirth and the mother’s gestational weight gain during pregnancy. Results: In the group of 7–11-year-olds, the maternal weight gain during pregnancy was higher in obese children than in children with normal weight (18.8 kg vs. 14.3 kg; p = 0.002). This relationship was shown analogously in the group of 7–11-years-olds boys (20.6 kg vs. 15.1 kg; p = 0.005). Positive correlations were also shown between mother’s gestational weight gain and the BMI percentage of the whole group (p = 0.004). In the case of the mother’s age, no statistically significant relationship was found with the child’s weight category. Conclusions: Mothers’ weight gain during pregnancy is a factor that promotes overweightness and obesity in the child. Maternal age at birth does not appear to lead to any propensity toward overweightness and obesity in the later life of a child. Full article

(This article belongs to the Special Issue Risks Associated with Obesity in Pregnancy, for the Mother and Baby)

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13 pages, 250 KiB

Open AccessArticle

Effect of Excessive Body Weight and Psoriasis in Women Undergoing ICSI Procedure and State of Health of the Newborn

by Anita Wdowiak-Filip, Artur Wdowiak, Dorota Raczkiewicz, Joanna Bartosińska and Iwona Bojar

J. Clin. Med. 2020, 9(11), 3628; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9113628 - 11 Nov 2020

Cited by 2 | Viewed by 1529

Abstract

Excessive body weight and some concomitant diseases, such as psoriasis, accompany women treated due to infertility by intracytoplasmic sperm injection (ICSI). This study is aimed to assess effect of obesity and psoriasis on quality of egg cells, embryos, course of pregnancy, and state of a newborn after treatment with ICSI. A total of 140 women were included into the study (110 healthy women and 30 with psoriasis). Among healthy women, BMI negatively correlated with total recovery rate, total oocyte score, blastocyst formation rate (BFR) and amount and quality of blastocysts (r < 0, p < 0.001). The relationships were similar in psoriasis, however apart from average blastocyst quality (p = 0.17) and BFR (p = 0.352). In healthy patients, BMI negatively correlated with gestational age at delivery (r = −0.444, p = 0.010) and APGAR (r = −0.481, p = 0.005). An excess of adipose tissue exerts an unfavourable effect on female reproductive functions, especially with a simultaneous burden of psoriasis. Excessive body weight is conducive to development of gestational diabetes and shortens the duration of pregnancy. The burden of psoriasis in combination with excessive body weight has an impact on the risk of occurrence of intrauterine growth restriction of foetus. Overweight and obesity negatively affect the state of a newborn, measured using APGAR scale. Full article

(This article belongs to the Special Issue Risks Associated with Obesity in Pregnancy, for the Mother and Baby)

14 pages, 434 KiB

Open AccessArticle

Fetal and Placental Weight in Pre-Gestational Maternal Obesity (PGMO) vs. Excessive Gestational Weight Gain (EGWG)—A Preliminary Approach to the Perinatal Outcomes in Diet-Controlled Gestational Diabetes Mellitus

by Mariusz Gujski, Dariusz Szukiewicz, Marta Chołuj, Włodzimierz Sawicki and Iwona Bojar

J. Clin. Med. 2020, 9(11), 3530; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9113530 - 31 Oct 2020

Cited by 8 | Viewed by 1932

Abstract

Both pre-gestational maternal obesity (PGMO) and excessive gestational weight gain (EGWG) increase the risk of gestational diabetes mellitus (GDM). Here, we conducted a retrospective study to comparatively examine the relation between fetal birth weight (FW) and placental weight (PW) in PGMO (n = 100) compared to EGWG (n = 100) with respect to perinatal outcomes in diet-controlled GDM. The control group was made up of 100 healthy pregnancies. The mean FW and the mean PW in EGWG were correlated with lowered fetal weight/placental weight ratio (FW/PW ratio). The percentage of births completed by cesarean section accounted for 47%, 32%, and 18% of all deliveries (EGWG, PGMO, and controls, respectively), with the predominance of FW-related indications for cesarean section. Extended postpartum hospital stays due to neonate were more frequent in EGWG, especially due to neonatal jaundice (p < 0.05). The results indicate the higher perinatal risk in mothers with EGWG compared to PGMO during GDM-complicated pregnancy. Further in-depth comparative studies involving larger patient pools are needed to validate these findings, the intent of which is to formulate guidelines for GDM patients in respect to management of PGMO and EGWG. Full article

(This article belongs to the Special Issue Risks Associated with Obesity in Pregnancy, for the Mother and Baby)

18 pages, 1251 KiB

Open AccessFeature PaperArticle

Smoking and Smoking Cessation in the Risk for Fetal Growth Restriction and Low Birth Weight and Additive Effect of Maternal Obesity

by Małgorzata Lewandowska, Barbara Więckowska, Lidia Sztorc and Stefan Sajdak

J. Clin. Med. 2020, 9(11), 3504; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9113504 - 29 Oct 2020

Cited by 9 | Viewed by 2171

Abstract

Many studies have shown that neonates of smoking mothers have a lower birth weight, but several issues remain poorly studied, e.g., the effects of giving up smoking or the combined effects of smoking and maternal obesity. Therefore, we evaluated a prospective cohort of 912 mothers in a single pregnancy, recruited in Poland, in 2015−2016. In the cohort, we recorded 72 (7.9%) newborns with birth weight <10th percentile, 21 (2.3%) fetal growth restriction (FGR) cases, and 60 (6.6%) low birth weight (LBW, <2500 g) newborns. In the cohort, 168 (18.4%) women smoked before pregnancy; the mean number of cigarettes/day was 10.8 (1–30), and the mean number of years of cigarette smoking was 8.5 (1–25). Among smokers, 57 (6.3%) women smoked in the first trimester. Adjusted odds ratio (AOR) of newborn outcomes (with 95% confidence intervals, CI) was calculated in multi-dimensional logistic regressions. Compared to participants who had never smoked, smoking before pregnancy was associated with a higher odds ratio of birth weight <10th percentile (AOR = 1.93, CI: 1.08–3.44, p = 0.027), but the result for LBW (AOR = 2.76, CI: 1.05–7.26, p = 0.039) and FGR (AOR = 1.13, CI: 0.38–3.36, p = 0.822) had the wider confidence interval or was insignificant. Effects of smoking cessation before pregnancy were statistically insignificant for the studied outcomes. Smoking in the first trimester was associated with a higher risk of birth weight <10th percentile (AOR = 4.68, CI: 2.28–9.62, p < 0.001), LBW (AOR = 6.42, CI: 1.84–22.36, p = 0.004), and FGR (AOR = 3.60, CI: 0.96–13.49, p = 0.057). Smoking cessation in the second/third trimester was associated with a higher odds ratio of birth weight <10th percentile (AOR = 4.54, CI: 1.58–13.02, p = 0.005), FGR (AOR = 3.36, CI: 0.6–18.74, p = 0.167), and LBW (AOR = 2.14, CI: 0.62–7.36), p = 0.229), to a similar degree to smoking in the first trimester. The odds ratios were higher in the subgroup of pre-pregnancy body mass index ≥25 kg/m² for the risk of birth weight <10th percentile (AOR = 6.39, CI: 2.01–20.34, p = 0.002) and FGR (AOR = 6.25, CI: 0.86–45.59, p = 0.071). The length of cigarette smoking time was also the risk factor for studied outcomes. Conclusions: Smoking in the first trimester increased the studied risks, and the coexistence of excessive maternal weight increased the effects. Smoking cessation during the second/third trimester did not have a protective effect. Full article

(This article belongs to the Special Issue Risks Associated with Obesity in Pregnancy, for the Mother and Baby)

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13 pages, 422 KiB

Open AccessArticle

The Influence of Gestational Diabetes Mellitus upon the Selected Parameters of the Maternal and Fetal System of Insulin-Like Growth Factors (IGF-1, IGF-2, IGFBP1-3)—A Review and a Clinical Study

by Tomasz Gęca and Anna Kwaśniewska

J. Clin. Med. 2020, 9(10), 3256; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9103256 - 12 Oct 2020

Cited by 12 | Viewed by 4450

Abstract

Background: Gestational diabetes mellitus (GDM), defined as impaired glucose tolerance with onset or first recognition in pregnancy, increases the risk of not only maternal but also fetal and neonatal complications. Given the structural similarity of insulin-like growth factors with insulin and participation of components of the insulin-like growth factor system in glucose homeostasis, we hypothesized that the IGF axis is involved in the development of GDM complications or its pathogenesis. The aim of this study was to evaluate the effect of GDM on the selected parameters of the insulin-like growth factors (IGF-1, IGF-2, IGFBP1-3) in the maternal and fetal blood. Methods: The clinical material of this case-control study included 109 pregnant women and their offspring. The study group (n = 120) consisted of 60 patients with diagnosed gestational diabetes and their newborn babies. The control group (n = 98) comprised 49 healthy parturients and their offspring. We measured the concentrations of IGF-1, IGF-2, IGFBP-1, IGFBP-2, IGFBP-3, insulin and glucose made by the ELISA method in peripheral blood serum in patients suffering from GDM and pregnant women without GDM, and in the umbilical cord blood of newborn babies born to them. Results: The analysis of concentrations of IGF-1, -2 and IGFBP-3 in peripheral blood as well as umbilical cord blood did not demonstrate a statistically significant difference between the study group and the control group. Significantly lower concentration of IGFBP-1, IGFBP-2 in peripheral blood and in umbilical cord blood was detected in the study group in comparison to the control group. A statistically positive correlation between the concentration of IGF-1 in umbilical cord serum of newborn babies born to women with gestational diabetes and the length of a baby after its birth was observed. Conclusions: Gestational diabetes mellitus does not significantly affect the concentrations of IGF-1, -2, IGFBP-3 in the peripheral blood and umbilical cord blood, but has the greatest influence on maternal and fetal IGFBP-2 concentrations. A positive correlation between the concentration of IGF-1 in umbilical cord blood and the length of a newborn suggests an influence of IGF-1 on the process of fetal development. Full article

(This article belongs to the Special Issue Risks Associated with Obesity in Pregnancy, for the Mother and Baby)

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13 pages, 1445 KiB

Open AccessArticle

by Tomasz Gęca, Maciej Kwiatek, Arkadiusz Krzyżanowski and Anna Kwaśniewska

J. Clin. Med. 2020, 9(8), 2587; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9082587 - 10 Aug 2020

Cited by 2 | Viewed by 2034

Abstract

Background: Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnant women, defined as any degree of glucose intolerance with onset or first detected during pregnancy. Explanation of its pathogenesis is extremely important due to the possibility of preventing serious maternal and fetal complications. The aim of the study was to evaluate the concentrations of two molecules: C1q/tumor necrosis factor-related protein-3 (CTRP-3) and pigment epithelium-derived factor (PEDF) which may possibly participate in GDM development. To our knowledge, this is the first study in pregnant women with GDM evaluating CTRP-3 level. Methods: Serum CTRP-3 and PEDF concentration and clinical characteristics were detected in 172 pregnant women. These women were divided into two groups: normal glucose tolerance group (NGT, n = 54) and gestational diabetes mellitus group (GDM, n = 118). This second group was further divided into two subgroups depending on the treatment used: GDM 1—diet only (n = 75) and GDM 2—insulin treatment (n = 43). Results: Our study did not reveal any statistically significant difference between the concentration of PEDF in the control and GDM group. In our study there was a significantly higher concentration of CTRP-3 evaluated in the peripheral blood serum in patients with gestational diabetes (GDM) compared to those in the control group (8.84 vs. 4.79 ng/mL). Significantly higher values of CTRP-3 were observed in both the diet-treated subgroup and the group with insulin therapy when compared to control group (8.40 and 10.96, respectively vs. 4.79 ng/mL). Conclusion: PEDF concentration does not change in GDM, whereas an increased level of CTRP-3 may point to the key role of this adipokine in the development of GDM. Full article

(This article belongs to the Special Issue Risks Associated with Obesity in Pregnancy, for the Mother and Baby)

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13 pages, 1122 KiB

Open AccessArticle

Pre-Pregnancy Obesity, Excessive Gestational Weight Gain, and the Risk of Pregnancy-Induced Hypertension and Gestational Diabetes Mellitus

by Małgorzata Lewandowska, Barbara Więckowska and Stefan Sajdak

J. Clin. Med. 2020, 9(6), 1980; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm9061980 - 24 Jun 2020

Cited by 67 | Viewed by 7521

Abstract

Excessive pre-pregnancy weight is a known risk factor of pregnancy complications. The purpose of this analysis was to assess the relationship between several categories of maternal weight and the risk of developing hypertension and diabetes in pregnancy, and the relationship of these complications with the results of the newborn. It was carried out in a common cohort of pregnant women and taking into account the influence of disturbing factors. Our analysis was conducted in a prospective cohort of 912 Polish pregnant women, recruited during 2015–2016. We evaluated the women who subsequently developed diabetes with dietary modification (GDM-1) (n = 125) and with insulin therapy (GDM-2) (n = 21), as well as the women who developed gestational hypertension (GH) (n = 113) and preeclampsia (PE) (n = 24), compared to the healthy controls. Odds ratios of the complications (and confidence intervals (95%)) were calculated in the multivariate logistic regression. In the cohort, 10.8% of the women had pre-pregnancy obesity (body mass index (BMI) ≥ 30 kg/m²), and 36.8% had gestational weight gain (GWG) above the range of the Institute of Medicine recommendation. After correction for excessive GWG and other confounders, pre-pregnancy obesity (vs. normal BMI) was associated with a higher odds ratio of GH (AOR = 4.94; p < 0.001), PE (AOR = 8.61; p < 0.001), GDM-1 (AOR = 2.99; p < 0.001), and GDM-2 (AOR = 11.88; p <0.001). The threshold risk of development of GDM-2 occurred at lower BMI values (26.9 kg/m²), compared to GDM-1 (29.1 kg/m²). The threshold point for GH was 24.3 kg/m², and for PE 23.1 kg/m². For GWG above the range (vs. GWG in the range), the adjusted odds ratios of GH, PE, GDM-1, and GDM-2 were AOR = 1.71 (p = 0.045), AOR = 1.14 (p = 0.803), AOR = 0.74 (p = 0.245), and AOR = 0.76 (p = 0.672), respectively. The effect of maternal edema on all the results was negligible. In our cohort, hypertension and diabetes were associated with incorrect birth weight and gestational age at delivery. Conclusions: This study highlights the importance and influence of excessive pre-pregnancy maternal weight on the risk of pregnancy complications such as diabetes and hypertension which can impact fetal outcomes. Full article

(This article belongs to the Special Issue Risks Associated with Obesity in Pregnancy, for the Mother and Baby)

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Review

Jump to: Research

22 pages, 1406 KiB

Open AccessReview

A Systematic Review and Meta-Analysis of Wound Complications after a Caesarean Section in Obese Women

by Aneta Słabuszewska-Jóźwiak, Jacek Krzysztof Szymański, Łukasz Jóźwiak and Beata Sarecka-Hujar

J. Clin. Med. 2021, 10(4), 675; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10040675 - 10 Feb 2021

Cited by 10 | Viewed by 3124

Abstract

(1) Background: Caesarean sections in obese patients are associated with an increased risk of surgical wound complications, including hematomas, seromas, abscesses, dehiscence, and surgical site infections. The aim of the present study is to perform a meta-analysis and systematic review of the current literature focusing on the strategies available to decrease wound complications in this population. (2) Methods: We reviewed the data available from the PubMed and the Science Direct databases concerning wound complications after caesarean sections in obese women. The following key words were used: “caesarean section”, “cesarean section”, “wound complication”, “wound morbidity”, and “wound infection”. A total of 540 papers were retrieved, 40 of which were selected for the final systematic review and whereas 21 articles provided data for meta-analysis. (3) Results: The conducted meta-analyses revealed that the use of prophylactic drainage does not increase the risk of wound complications in obese women after a caesarean sections (pooled OR = 1.32; 95% CI 0.64–2.70, p = 0.45) and that vertical skin incisions increase wound complications (pooled OR = 2.48; 95% CI 1.85–3.32, p < 0.01) in obese women, including extremely obese women. (4) Conclusions: Subcutaneous drainage does not reduce the risk of a wound complications, wound infections, and fever in obese women after caesarean sections. Negative prophylactic pressure wound therapy (NPWT) may reduce the risk of surgical site infections. The evidence of using a prophylactic dose of an antibiotic before the caesarean section is still lacking. Full article

(This article belongs to the Special Issue Risks Associated with Obesity in Pregnancy, for the Mother and Baby)

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