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Mothers who are obese carry heavier fetuses and have lower rates of small for gestational age (<10th birthweight centile) infants. However, their infants may be growth-restricted (with an increased risk of stillbirth) at a higher birthweight centile compared with infants from healthy-weight women. This study aimed to quantify the birthweight centile at which the risk of stillbirth in infants born to obese women equaled that of <10th-centile infants born to healthy-weight women, and clarify the relationship between maternal body mass index, infant size, and stillbirth. We conducted a retrospective cohort study on all infants born in Victoria, Australia, from 2009 to 2019 (754,946 cases for analysis). We applied uncustomized birthweight centiles to all infants, and stratified the maternal cohort by body mass index (<20 kg/m2, 20–25 kg/m2, 25–30 kg/m2, 30–35 kg/m2, 35–40 kg/m2, ≥40 kg/m2). For each body mass index category, we assessed proportions of infants born <10th centile and <3rd centile, stillbirth rates among infants of all sizes, and small for gestational age infants. We calculated the stillbirth rate (per 1000) and relative risk (risk of stillbirth if born <10th centile vs >10th centile) for healthy-weight women (body mass index, 20–25 kg/m2). We then determined the birthweight centile for infants born to mothers within other body mass index categories that equaled that rate or risk. Stillbirth rates increased with increasing maternal body mass index. Infants classified as small for gestational age (<10th centile) from mothers with high body mass index had a higher risk of stillbirth (relative risk, 3.15; 95% confidence interval, 2.22–4.47; for mothers with body mass index ≥40 kg/m2 vs healthy-weight mothers [body mass index, 20–25 kg/m2]). The stillbirth rate (stillborn infants per 1000 births) among <10th-centile infants born to healthy-weight mothers was 7.5 per 1000. The same stillbirth rate was observed at higher birthweight centiles for infants of women with higher body mass index (<18th centile for those with a body mass index of 25–30 kg/m2, <25th centile for body mass index of 30–35 kg/m2, <31st centile for body mass index of 35–40 kg/m2, <41st centile for body mass index of ≥40 kg/m2). The relative risk of stillbirth among small for gestational age infants of healthy-weight mothers was 5.46 (95% confidence interval, 4.65–6.40). The birthweight centile with a comparable relative risk of stillbirth increased with increasing body mass index (<16th centile for women with body mass index of 25–30 kg/m2, <19th centile for body mass index of 30–35 kg/m2, <28th centile for body mass index of 35–40 kg/m2, <30th centile for body mass index ≥40 kg/m2). Obesity affects the relationship between infant size and perinatal mortality. The stillbirth risk observed in <10th-centile infants from healthy-weight mothers occurs at higher birthweight centiles with overweight or obese mothers. Clinicians should be aware that the same infant risk exists at a higher birthweight centile for women with higher body mass index. [ABSTRACT FROM AUTHOR]

Background Obesity and being overweight are becoming epidemic, and indeed, the proportion of such women of reproductive age has increased in recent times. Being overweight or obese prior to pregnancy is a risk factor for gestational diabetes mellitus, and increases the risk of adverse pregnancy outcome for both mothers and their offspring. Furthermore, the combination of gestational diabetes mellitus with obesity/overweight status may increase the risk of adverse pregnancy outcome attributable to either factor alone. Regular exercise has the potential to reduce the risk of developing gestational diabetes mellitus and can be used during pregnancy; however, its efficacy remain controversial. At present, most exercise training interventions are implemented on Caucasian women and in the second trimester, and there is a paucity of studies focusing on overweight/obese pregnant women. Objective We sought to test the efficacy of regular exercise in early pregnancy to prevent gestational diabetes mellitus in Chinese overweight/obese pregnant women. Study Design This was a prospective randomized clinical trial in which nonsmoking women age >18 years with a singleton pregnancy who met the criteria for overweight/obese status (body mass index 24≤28 kg/m 2 ) and had an uncomplicated pregnancy at <12 +6 weeks of gestation were randomly allocated to either exercise or a control group. Patients did not have contraindications to physical activity. Patients allocated to the exercise group were assigned to exercise 3 times per week (at least 30 min/session with a rating of perceived exertion between 12-14) via a cycling program begun within 3 days of randomization until 37 weeks of gestation. Those in the control group continued their usual daily activities. Both groups received standard prenatal care, albeit without special dietary recommendations. The primary outcome was incidence of gestational diabetes mellitus. Results From December 2014 through July 2016, 300 singleton women at 10 weeks’ gestational age and with a mean prepregnancy body mass index of 26.78 ± 2.75 kg/m 2 were recruited. They were randomized into an exercise group (n = 150) or a control group (n = 150). In all, 39 (26.0%) and 38 (25.3%) participants were obese in each group, respectively. Women randomized to the exercise group had a significantly lower incidence of gestational diabetes mellitus (22.0% vs 40.6%; P < .001). These women also had significantly less gestational weight gain by 25 gestational weeks (4.08 ± 3.02 vs 5.92 ± 2.58 kg; P < .001) and at the end of pregnancy (8.38 ± 3.65 vs 10.47 ± 3.33 kg; P < .001), and reduced insulin resistance levels (2.92 ± 1.27 vs 3.38 ± 2.00; P = .033) at 25 gestational weeks. Other secondary outcomes, including gestational weight gain between 25-36 gestational weeks (4.55 ± 2.06 vs 4.59 ± 2.31 kg; P = .9), insulin resistance levels at 36 gestational weeks (3.56 ± 1.89 vs 4.07 ± 2.33; P = .1), hypertensive disorders of pregnancy (17.0% vs 19.3%; odds ratio, 0.854; 95% confidence interval, 0.434–2.683; P = .6), cesarean delivery (except for scar uterus) (29.5% vs 32.5%; odds ratio, 0.869; 95% confidence interval, 0.494–1.529; P = .6), mean gestational age at birth (39.02 ± 1.29 vs 38.89 ± 1.37 weeks’ gestation; P = .5); preterm birth (2.7% vs 4.4%, odds ratio, 0.600; 95% confidence interval, 0.140–2.573; P = .5), macrosomia (defined as birthweight >4000 g) (6.3% vs 9.6%; odds ratio, 0.624; 95% confidence interval, 0.233–1.673; P = .3), and large-for-gestational-age infants (14.3% vs 22.8%; odds ratio, 0.564; 95% confidence interval, 0.284–1.121; P = .1) were also lower in the exercise group compared to the control group, but without significant difference. However, infants born to women following the exercise intervention had a significantly lower birthweight compared with those born to women allocated to the control group (3345.27 ± 397.07 vs 3457.46 ± 446.00 g; P = .049). Conclusion Cycling exercise initiated early in pregnancy and performed at least 30 minutes, 3 times per week, is associated with a significant reduction in the frequency of gestational diabetes mellitus in overweight/obese pregnant women. And this effect is very relevant to that exercise at the beginning of pregnancy decreases the gestational weight gain before the mid-second trimester. Furthermore, there was no evidence that the exercise prescribed in this study increased the risk of preterm birth or reduced the mean gestational age at birth. [ABSTRACT FROM AUTHOR]

Maternal sleep-disordered breathing is associated with adverse pregnancy outcomes and is considered to be deleterious to the developing fetus. Maternal obesity potentiates sleep-disordered breathing, which, in turn, may contribute to the effect of maternal obesity on adverse fetal outcomes. However, only a few empirical studies have evaluated the contemporaneous effects of maternal sleep-disordered breathing events on fetal well-being. These events include apnea and hypopnea with accompanying desaturations in oxyhemoglobin. This study aimed to reconcile contradictory findings on the associations between maternal apnea or hypopnea events and clinical indicators of fetal compromise. It also sought to broaden the knowledge base by examining the fetal heart rate and heart rate variability before, during, and after episodes of maternal apnea or hypopnea. To accomplish this, we employed overnight polysomnography, the gold standard for ascertaining maternal sleep-disordered breathing, and synchronized it with continuous fetal electrocardiography. A total of 84 pregnant women with obesity (body mass index > 30 kg/m2) participated in laboratory-based polysomnography with digitized fetal electrocardiography recordings during or near 36 weeks of gestation. Sleep was recorded, on average, for 7 hours. Decelerations in fetal heart rate were identified. Fetal heart rate and heart rate variability were quantified before, during, and after each apnea or hypopnea event. Event-level intensity (desaturation magnitude, duration, and nadir O 2 saturation level) and person-level characteristics based on the full overnight recording (apnea-hypopnea index, mean O 2 saturation, and O 2 saturation variability) were analyzed as potential moderators using linear mixed effects models. A total of 2936 sleep-disordered breathing events were identified, distributed among all but 2 participants. On average, participants exhibited 8.7 episodes of apnea or hypopnea per hour (mean desaturation duration, 19.1 seconds; mean O 2 saturation nadir, 86.6% per episode); nearly half (n=39) of the participants met the criteria for obstructive sleep apnea. Only 45 of 2936 apnea or hypopnea events were followed by decelerations (1.5%). Conversely, most (n=333, 88%) of the 378 observed decelerations, including the prolonged ones, did not follow an apnea or a hypopnea event. Maternal sleep-disordered breathing burden, body mass index, and fetal sex were unrelated to the number of decelerations. Fetal heart rate variability increased during events of maternal apnea or hypopnea but returned to initial levels soon thereafter. There was a dose-response association between the size of the increase in fetal heart rate variability and the maternal apnea-hypopnea index, event duration, and desaturation depth. Longer desaturations were associated with a decreased likelihood of the variability returning to baseline levels after the event. The mean fetal heart rate did not change during episodes of maternal apnea or hypopnea. Episodes of maternal sleep apnea and hypopnea did not evoke decelerations in the fetal heart rate despite the predisposing risk factors that accompany maternal obesity. The significance of the modest transitory increase in fetal heart rate variability in response to apnea and hypopnea episodes is not clear but may reflect compensatory, delimited autonomic responses to momentarily adverse conditions. This study found no evidence that episodes of maternal sleep-disordered breathing pose an immediate threat, as reflected in fetal heart rate responses, to the near-term fetus. [ABSTRACT FROM AUTHOR]

Among women with symptomatic uterovaginal prolapse undergoing vaginal surgery in the Vaginal hysterectomy with Native Tissue Vault Suspension vs Sacrospinous Hysteropexy with Graft Suspension (Study for Uterine Prolapse Procedures Randomized Trial) trial, sacrospinous hysteropexy with graft (hysteropexy) resulted in a lower composite surgical failure rate than vaginal hysterectomy with uterosacral suspension over 5 years. This study aimed to identify factors associated with the rate of surgical failure over 5 years among women undergoing sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral suspension for uterovaginal prolapse. This planned secondary analysis of a comparative effectiveness trial of 2 transvaginal apical suspensions (NCT01802281) defined surgical failure as either retreatment of prolapse, recurrence of prolapse beyond the hymen, or bothersome prolapse symptoms. Baseline clinical and sociodemographic factors for eligible participants receiving the randomized surgery (N=173) were compared across categories of failure (≤1 year, >1 year, and no failure) with rank-based tests. Factors with adequate prevalence and clinical relevance were assessed for minimally adjusted bivariate associations using piecewise exponential survival models adjusting for randomized apical repair and clinical site. The multivariable model included factors with bivariate P <.2, additional clinically important variables, apical repair, and clinical site. Backward selection determined final retained risk factors (P <.1) with statistical significance evaluated by Bonferroni correction (P <.005). Final factors were assessed for interaction with type of apical repair at P <.1. Association is presented by adjusted hazard ratios and further illustrated by categorization of risk factors. In the final multivariable model, body mass index (increase of 5 kg/m2: adjusted hazard ratio, 1.7; 95% confidence interval, 1.3–2.2; P <.001) and duration of prolapse symptoms (increase of 1 year: adjusted hazard ratio, 1.1; 95% confidence interval, 1.0–1.1; P <.005) were associated with composite surgical failure, where rates of failure were 2.9 and 1.8 times higher in women with obesity and women who are overweight than women who have normal weight and women who are underweight (95% confidence intervals, 1.5–5.8 and 0.9–3.5) and 3.0 times higher in women experiencing >5 years prolapse symptoms than women experiencing ≤5 years prolapse symptoms (95% confidence interval, 1.8–5.0). Sacrospinous hysteropexy with graft had a lower rate of failure than hysterectomy with uterosacral suspension (adjusted hazard ratio, 0.6; 95% confidence interval, 0.4–1.0; P =.05). The interaction between symptom duration and apical repair (P =.07) indicated that failure was less likely after hysteropexy than hysterectomy for those with ≤5 years symptom duration (adjusted hazard ratio, 0.5; 95% confidence interval, 0.2–0.9), but not for those with >5 years symptom duration (adjusted hazard ratio, 1.0; 95% confidence interval 0.5–2.1). Obesity and duration of prolapse symptoms have been determined as risk factors associated with surgical failure over 5 years from transvaginal prolapse repair, regardless of approach. Providers and patients should consider these modifiable risk factors when discussing treatment plans for bothersome prolapse. [ABSTRACT FROM AUTHOR]

Maternal obesity in pregnancy is associated with increased maternal and fetal risks. Pregnancy management should include counseling, screening, and optimization of maternal health, increased fetal surveillance, and preparation for parturition. A multidisciplinary approach should be implemented including collaboration from obstetricians, nutritionists, anesthesiologists, social workers, and neonatologists to optimize perinatal outcomes. Pregnancy is an ideal window of opportunity to influence both the patient’s long-term health and the health of the offspring. [ABSTRACT FROM AUTHOR]

An increasing number of women are entering pregnancy in an overweight or obese state. Obese women and their offspring are at increased risk of adverse perinatal outcomes, which may be improved by regular moderate-intensity antenatal exercise. Current guidelines recommend that all pregnant women without contraindications engage in ≥30 minutes of moderate-intensity exercise on a daily basis. However, obese women are usually less physically active and tend to further reduce activity levels during pregnancy. This commentary summarizes the potential short- and long-term benefits of antenatal exercise in obese pregnant women, highlights the challenges they face, and discusses means of improving their exercise levels. In addition, we make recommendations on exercise prescription for pregnancies complicated by obesity. [ABSTRACT FROM AUTHOR]

Objective We sought to evaluate inadequate gestational weight gain and fetal growth among overweight and obese women. Study Design We conducted an analysis of prospective singleton term pregnancies in which 1053 overweight and obese women gained >5 kg (14.4 ± 6.2 kg) or 188 who either lost or gained ≤5 kg (1.1 ± 4.4 kg). Birthweight, fat mass, and lean mass were assessed using anthropometry. Small for gestational age (SGA) was defined as ≤10th percentile of a standard US population. Univariable and multivariable analysis evaluated the association between weight change and neonatal morphometry. Results There was no significant difference in age, race, smoking, parity, or gestational age between groups. Weight loss or gain =5 kg was associated with SGA, 18/188 (9.6%) vs 51/1053 (4.9%); (adjusted odds ratio, 2.6; 95% confidence interval, 1.4-4.7; P = .003). Neonates of women who lost or gained =5 kg had lower birthweight (3258 ± 443 vs 3467 ± 492 g, P < .0001), fat mass (403 ± 175 vs 471 ± 193 g, P < .0001), and lean mass (2855 ± 321 vs 2995 ± 347 g, P < .0001), and smaller length, percent fat mass, and head circumference. Adjusting for diabetic status, prepregnancy body mass index, smoking, parity, study site, gestational age, and sex, neonates of women who gained =5 kg had significantly lower birthweight, lean body mass, fat mass, percent fat mass, head circumference, and length. There were no significant differences in neonatal outcomes between those who lost weight and those who gained ≤5 kg. Conclusion In overweight and obese women weight loss or gain =5 kg is associated with increased risk of SGA and decreased neonatal fat mass, lean mass, and head circumference. [ABSTRACT FROM AUTHOR]

Objective: Obese adult pregnant women have increased rates of maternal and neonatal complications. Our objective was to examine adverse obstetric outcomes in overweight adolescent women. Study design: In a retrospective case-control study of 4822 women who were < 19 years old, 3324 appropriate-weight subjects (body mass index, 18.5–24.9 kg/m2) and 1498 overweight subjects (body mass index, ≥ 25 kg/m2) were compared. Frequencies and odds ratios for adverse maternal or neonatal events were computed. Results: Compared with appropriate-weight adolescents, primary cesarean delivery (odds ratio, 1.6; 95% CI, 1.4–1.9), failure to progress/cephalopelvic disproportion (odds ratio 1.6; 95% CI, 1.3–1.9), labor induction (odds ratio, 1.4; 95% CI, 1.3–1.7), pregnancy-induced hypertension (odds ratio, 1.8; 95% CI, 1.4–2.3), preeclampsia (odds ratio, 1.7; 95% CI, 1.2–2.4), and gestational diabetes mellitus (odds ratio, 3.0, 95% CI, 1.6–5.4) were significantly more common in overweight adolescents. Significant neonatal findings included an increased incidence of macrosomia (odds ratio, 1.6; 95% CI, 1.2–2.0) and a decreased incidence of low birth weight infants (odds ratio, 0.6; 95% CI, 0.4–0.8) and small for gestational age infants (odds ratio, 0.8; 95% CI, 0.%1.0). Conclusion: Overweight adolescent women are at increased risk for adverse neonatal and perinatal outcomes. With rates of overweight increasing overall, overweight in the gravid adolescent is a pressing perinatal and public health concern. [ABSTRACT FROM AUTHOR]

Objective: In the United States, obesity has increased steadily. As obesity in pregnancy is a high-risk obstetric situation, important questions are whether there has been a trend toward higher prepregnancy body mass indexes (BMIs) in women who have become pregnant and if there are subgroups at risk. The objective of this study was to analyze the shifts, if any, in the prepregnancy BMIs in women who delivered. Study design: Analysis of the birth certificate data collected in a regional perinatal data system of all live born deliveries (79,022 cases) occurring in a contiguous 8-county area in upstate New York from 1999 to 2003. Results: From 1999 to 2003, there was an overall increase in the mean prepregnancy BMI of the total delivery population (P < .01). There was a relative I 1% increase in the Institute of Medicine (IOM) overweight (P < .01) and a relative 8% increase in the obese (P < .01) categories. There was an increase in the numbers of women in the IOM overweight or obese categories in these subgroups (P < .05): age (all subgroups), ethnicity (white and black), education (all subgroups), insurance type (all subgroups), previous live births (all subgroups), urbanization status (all subgroups), median family income of ZIP code area (all subgroups), and smoking (both smokers and nonsmokers). Conclusion: There was a significant increase toward higher prepregnancy BMIs across multiple subgroups. Our study demonstrates that increased prepregnancy BMI is an issue that spans almost the entire spectrum of subgroups of patients who delivered. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare adipokines' levels between women with and without preeclampsia based on maternal body mass index (BMI). Study design: This was a cross-sectional study among third-trimester pregnancies with preeclampsia (PIH) compared with normotensive controls. Serum levels of adiponectin, leptin, and resistin were measured before delivery by radioimmunoassay or enzyme-linked immunosorbent assay (ELISA). Results: The study included 22 normotensive and 77 PIH women. Leptin levels increased with maternal BMI. In patients with severe preeclampsia, overweight, and obese women had increased leptin levels (33.4 ± 14.8 vs 23.0 ± 10.8 ng/mL respectively, P = .02), and decreased adiponectin levels (8.4 ± 5.3 vs 12.6 ± 6.0 ng/mL, P = .03) compared with normal weight women. In women with BMI <25 kg/m², adiponectin levels increased in patients with preeclampsia compared with controls (11.5 ± 5.6 vs 9.6 ± 4.6 and 7.0 ± 3.2 ng/mL, respectively, P = .005). There was no association between resistin levels and preeclampsia or maternal BMI. Conclusion: Women with severe preeclampsia and BMI ⩾25 kg/m² have decreased adiponectin and increased leptin levels, while normal weight women with preeclampsia have increased adiponectin levels. [ABSTRACT FROM AUTHOR]

Objective: We sought to investigate the relationship between prepregnancy weight, treatment modality (diet or insulin), level of glycemic control, and pregnancy outcome. Study design: We recruited women with gestational diabetes (GDM) from inner city prenatal clinics. All women were instructed in the use of an intensified management protocol using memory reflectance meters. Outcomes were analyzed according to maternal prepregnancy body mass index (BMI, kg/m²) categories: normal weight (BMI 18.5–24.9), overweight tBMI 25–20.9), and obese (BMI ≥ 30), and by diet or insulin therapy and glycemic control (mean blood glucose < 100 mg/dL = good control). Pregnancy outcome variables included a composite outcome (at least 1 of the following: neonatal metabolic complications, huge-for-gestational age or macrosomic infants. NICU admission for > 24 hours, and the need for respiratory support) (not including oxygen therapy). In addition to composite outcome, a bivariate analysis was performed for each single variable, including preeclampsia and cesarean section delivery. Results: Four thousand and one women were enrolled. Obese women who achieved targeted levels of glycemic control had comparable pregnancy outcomes to normal weight and overweight women only when they were treated with insulin. Normal weight women treated with diet therapy who achieved targeted levels of glycemic control had good outcomes, but obese women treated with diet therapy who achieved targeted levels of glycemic control nevertheless, had a 2- to 3qold higher risk for adverse pregnancy outcome when compared with overweight and normal weight patients with well-controlled GDM. Women with GDM who failed to achieve established levels of glycemic control had significantly higher adverse pregnancy outcomes in all 3 maternal weight groups. Conclusion: In obese women with BMI ≥30 with GDM, achievement of targeted levels of glycemic control was associated with enhanced outcome only it] women treated with insulin. [ABSTRACT FROM AUTHOR]

This study aims to identify recent population-based trends in maternal overweight and obesity and adverse outcomes. Study design: Statewide retrospective cohort study of birth certificate data for live singleton births to women in Utah between 1991 and 2001. Results: Prepregnancy overweight and obesity increased from 25.1% in 1991 to 35.2% in 2001, a 40.2% increase (prevalence ratio [PR] 1.40 [1.37-1.43]), whereas maternal obesity at delivery rose 36.2% from 28.7% to 39.1% (PR 1.36 [1.33-1.39]). The attributable fraction of cesarean delivery in overweight and obese women was 0.388 (0.369-0.407). Statewide, among all women having a cesarean delivery in 2001, 1 in 7 is attributable to overweight and obesity. Conclusion: This is the first state-wide analysis of maternal obesity trends demonstrating a significant increase in maternal overweight and obesity. Overweight and obese women are at increased risk of cesarean delivery, preeclampsia, eclampsia, dystocia, and macrosomia, risks that increase as the body mass index rises. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purpose of this study was to evaluate the effect of obesity on the success of the tensionfree vaginal tape (TVT) procedure for stress urinary incontinence. Specifically, do patients with a body mass index (BMI) of 35 kg/m² or greater have a lower cure rate of stress urinary incontinence? STUDY DESIGN: This retrospective cohort study identified 35 patient pairs who had undergone TVT in Winnipeg, Manitoba, Canada, for stress urinary incontinence from November 1999 to July 2001. Obese patients (defined as BMI greater than or equal to 35 kg/m²) were paired with nonobese patients (defined as BMI less than or equal to 30 kg/m²). The subjects were matched for age (within 5 years) and prior continence surgeries. Patients with a maximum urethral closure pressure of less than or equal to 20 cm H[sub 2]O were excluded. Follow-up was either by objective cough stress test or subjective cure assessed by telephone interview. Cure was defined as no postoperative stress incontinence. Statistical analysis was performed by conditional logistic regression for matched controls. RESULTS: The follow-up range was 6 to 24 months. There were seven failures in all, four in obese and three in nonobese patients, giving cure rates of 88.6% and 91.4%, respectively. This difference was not statistically significant (P > .05). There were five bladder perforations (identified at the time of the procedure), all occurring in nonobese patients (P < .05). CONCLUSION: These data do not demonstrate a difference in cure of TVT in obese versus nonobese patients. Given the finding of fewer complications, this procedure may be an ideal surgical treatment modality for stress urinary incontinence in obese women. Key words: Stress urinary incontinence; obesity; tension-free vaginal tape. [ABSTRACT FROM AUTHOR]

Examines the prevalence and prenatal predictors of postpartum anemia. Possible complications of pregnancy; Relationship between breast-feeding and anemia; Prevalence of postpartum anemia among obese women; Causes of anemia.

Background: Fetal fraction of cell-free DNA decreases with increasing maternal weight. Consequently, cell-free DNA screening for fetal aneuploidy has higher screen failures or "no call" rates in women with obesity owing to a low fetal fraction. The optimal timing of testing based on maternal weight is unknown.Objective: This study aimed to identify the optimal timing of initial cell-free DNA testing based on maternal weight and to identify the optimal timing of repeat cell-free DNA testing in cases with an initial screen failure.Study Design: This was a retrospective cohort study of women undergoing cell-free DNA for fetal aneuploidy screening between 9 and 18 weeks through a single laboratory over 1 year from 2018 to 2019. Fetal fraction change per week was calculated, and generalized linear models were used to calculate relative risk and 95% confidence interval of a no call result at given maternal weights and gestational ages.Results: The vast majority of samples (99.22%) received a test result. The risk of a no call result owing to a low fetal fraction was higher with increasing maternal weight. At 9 to 12 weeks, the rate of a no call result owing to a low fetal fraction in women who weighed <150 lb was 0.14% compared with 17.39% in women weighing >400 lb. Fetal fraction increased with increasing gestational age, although the incremental increase in fetal fraction over time is inversely proportional to maternal weight. At 13 to 18 weeks' gestation, 6.45% of women weighing >400 lb received a no call result owing to a low fetal fraction. In women in the highest weight category, >400 lb, fetal fraction increased 0.5% with each week of gestation.Conclusion: Although the risk of a no call result increases with maternal weight, cell-free DNA screening should be offered to all women at 9 to 12 weeks' gestation, allowing the option to have chorionic villus sampling after a positive test result. Pretest counseling for women with obesity should include the increased chance for a test failure. Most women weighing less than 400 lb will receive a test result and more than 80% of women with a weight of >400 lb will receive a test result at 9 to 12 weeks' gestation. Data regarding the expected increase in cell-free DNA fetal fraction per week may help guide the timing of a redraw to optimize test success. [ABSTRACT FROM AUTHOR]

Background: Obesity is a well-known risk factor for endometrial cancer, but the mechanisms of obesity-related carcinogenesis are not well defined, particularly for premenopausal women. With the continuing obesity epidemic, increases in the incidence of endometrial cancer and a younger age of diagnosis are often attributed to a hyperestrogenic state created by hormone production in adipose tissue, but significant knowledge gaps remain. The balance of estrogen-responsive signals has not been defined in the endometrium of premenopausal women with obesity, where obesity may not create hyperestrogenism in the context of ovaries being the primary source of estrogen production. Obesity is associated with a state of low-grade, chronic inflammation that can promote tumorigenesis, and it is also known that hormonal changes alter the immune microenvironment of the endometrium. However, limited research has been conducted on endometrial immune-response changes in women who have an increased risk for cancer due to obesity.Objective: Endometrial estrogen-regulated biomarkers, previously shown to be dysregulated in endometrial cancer, were evaluated in a cohort of premenopausal women to determine if obesity is associated with differences in the biomarker expression levels, which might reflect an altered risk of developing cancer. The expression of a multiplexed panel of immune-related genes was also evaluated for expression differences related to obesity.Study Design: Premenopausal women with a body mass index of ≥30 kg/m2 (n=97) or a body mass index of ≤25 kg/m2 (n=33) were prospectively enrolled in this cross-sectional study, which included the assessment of serum metabolic markers and a timed endometrial biopsy for pathologic evaluation, hormone-regulated biomarker analysis, and immune response gene expression analysis. Medical and gynecologic histories were obtained. Endometrial gene expression markers were also compared across the body mass index groups in a previous cohort of premenopausal women with an inherited cancer risk (Lynch syndrome).Results: In addition to known systemic metabolic differences, histologically normal endometria from women with obesity showed a decrease in gene expression of progesterone receptor (P=.0027) and the estrogen-induced genes retinaldehyde dehydrogenase 2 (P=.008), insulin-like growth factor 1 (P=.016), and survivin (P=.042) when compared with women without obesity. The endometrial biomarkers insulin-like growth factor 1, survivin, and progesterone receptor remained statistically significant in multivariate linear regression models. In contrast, women with obesity and Lynch syndrome had an increased expression of insulin-like growth factor 1 (P=.017). There were no differences in endometrial proliferation, and limited endometrial immune differences were observed.Conclusion: When comparing premenopausal women with and without obesity in the absence of endometrial pathology or an inherited cancer risk, the expression of the endometrial biomarkers does not reflect a local hyperestrogenic environment, but it instead reflects a decreased cancer risk profile that may be indicative of a compensated state. In describing premenopausal endometrial cancer risk, it may be insufficient to attribute a high-risk state to obesity alone; further studies are warranted to evaluate individualized biomarker profiles for differences in the hormone-responsive signals or immune response. In patients with Lynch syndrome, the endometrial biomarker profile suggests that obesity further increases the risk of developing cancer. [ABSTRACT FROM AUTHOR]

Background: Antimüllerian hormone is produced by small antral follicles and reflects ovarian reserve. Obesity is associated with lower serum antimüllerian hormone, but it is unclear whether lower levels of antimüllerian hormone in women with obesity reflect lower ovarian reserve.Objective: To determine whether lower antimüllerian hormone in women with obesity undergoing in vitro fertilization is associated with oocyte yield and live-birth rate.Materials and Methods: Retrospective cohort from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database of 13,316 women with obesity and 16,579 women with normal body mass index undergoing their first autologous in vitro fertilization with fresh transfers between 2012 and 2014. Normal body mass index was defined as body mass index 18.5-24.9 kg/m2, and obesity was defined as body mass index ≥30 kg/m2. Subjects with obesity were stratified as those with class 1 obesity (body mass index, 30.0-34.9 kg/m2), class 2 obesity (body mass index, 35.0-39.9 kg/m2), and class 3 obesity (body mass index, ≥40 kg/m2) based on the World Health Organization body mass index guidelines. Antimüllerian hormone levels were stratified as normal (>1.1 ng/mL), low (0.16-1-1 ng/mL), and undetectable (≤0.16 ng/mL). Multivariable modeling was used to assess oocyte yield using linear regression with a logarithmic transformation and odds of live birth using logistic regression.Results: Women with obesity were older (36.0 ± 4.8 vs 35.5 ± 4.8, P < .001), had lower antimüllerian hormone (1.8 ± 2.0 ng/mL vs 2.1 ± 2.0 ng/mL, P < .001), and had fewer oocytes retrieved (11.9 ± 7.3 vs 12.8 ± 7.7, P < .001) than women with normal body mass index. Lower oocyte yield was observed among women with obesity and normal antimüllerian hormone levels compared to women with normal body mass index and normal antimüllerian hormone levels (13.6 ± 7.3 vs 15.8 ± 8.1, P < .001). No difference in oocyte yield was observed among women with obesity and low antimüllerian hormone levels (P = .58) and undetectabl antimüllerian hormone (P = .11) compared to women with normal BMI and similar antimüllerian hormone levels. Among women with a body mass index ≥30 kg/m2, antimüllerian hormone levels were associated with the number of oocytes retrieved (β = 0.069; standard error, 0.005; P < .001) but not live-birth rate (odds ratio, 0.98; 95% confidence interval, 0.93-1.04, P = .57).Conclusion: Lower antimüllerian hormone in infertile women with obesity appears to reflect lower ovarian reserve, as antimüllerian hormone is associated with lower oocyte yield. Despite lower oocyte yield, lower antimüllerian hormone was not associated with lower live-birth rate among women with obesity. [ABSTRACT FROM AUTHOR]

Background: Hyperemesis gravidarum, excessive vomiting in pregnancy, affects approximately 0.3-3.0% of all pregnancies, but the risk is considerably higher in pregnancies following a hyperemetic pregnancy. The reported recurrence rate of hyperemesis gravidarum is wide, ranging from 15-81%, depending on study settings. Factors affecting recurrence of hyperemesis gravidarum are as yet insufficiently studied.Objective: We sought to evaluate the recurrence rate of hyperemesis gravidarum in subsequent pregnancies, to elucidate chronological patterns of recurrence of the condition, and to analyze maternal, environmental, and pregnancy-related factors associated with recurring hyperemesis gravidarum.Study Design: Out of all pregnancies ending in delivery in Finland from 2004 through 2011, data of women who had at least 1 pregnancy ending in delivery following a pregnancy diagnosed with hyperemesis gravidarum were retrieved from hospital discharge register and medical birth register (1836 women, 4103 pregnancies; 1836 index pregnancies and 2267 subsequent pregnancies). The first pregnancy with hyperemesis gravidarum diagnosis was chosen as the index pregnancy, and recurrence rate was calculated by comparing the number of hyperemetic pregnancies that followed the index pregnancy to the total number of pregnancies that followed the index pregnancy. Recurrence patterns of hyperemesis gravidarum were illustrated by presenting the chronological order of the women's pregnancies beginning from the index pregnancy to the end of the follow-up period. The associations between recurring hyperemesis and age, parity, prepregnancy body mass index, smoking, marital and socioeconomic status, domicile, month of delivery, assisted reproductive technology, sex, and number of fetuses were analyzed in both the index pregnancies and in pregnancies following the index pregnancy.Results: There were 544 pregnancies with a hyperemesis diagnosis and 1723 pregnancies without a hyperemesis diagnosis following the index pregnancies. The overall recurrence rate of hyperemesis gravidarum in pregnancies following the index pregnancy was 24%. In case of >1 subsequent pregnancy, 11% of women were diagnosed with hyperemesis in all of their pregnancies. In the index pregnancies, recurrence of hyperemesis gravidarum was more common among women with parity of 2 than parity of 1 (adjusted odds ratio, 1.33, P = .046). Overweight women (adjusted odds ratio, 0.58, P = .036) or women who smoked after the first trimester (adjusted odds ratio, 0.27, P < .001) had lower recurrence of hyperemesis. In the comparison of the subsequent pregnancies, quitting smoking in the first trimester (adjusted odds ratio, 0.32, P = .010) and smoking continued after the first trimester (adjusted odds ratio, 0.38, P = .002) were associated with lower odds of recurring hyperemesis. Female sex of the fetus was associated with higher odds of recurring hyperemesis (adjusted odds ratio, 1.29, P = .012).Conclusion: In the majority of pregnancies following an earlier hyperemetic pregnancy, hyperemesis gravidarum does not recur, but hyperemetic pregnancies occur in the next pregnancies with little predictability. Only few factors associated with recurring hyperemesis could be identified. Although estimating the probability of recurrence of hyperemesis gravidarum in a subsequent pregnancy based on a woman's first hyperemetic pregnancy turned out not to be feasible, it is reassuring to know that hyperemesis does not appear to become more likely with each pregnancy and that after 1 pregnancy with hyperemesis, the following pregnancy may be different. [ABSTRACT FROM AUTHOR]

This article has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been removed at the request of the Editors-in-Chief and Authors. The original publication reported that univariate analysis showed that a vertical skin incision in obese women undergoing Cesarean delivery was associated with a higher odds ratio for wound complications than a transverse skin incision. Multivariable analyses showed a reversal of the association (i.e. the odds of wound complications were lower in women with a vertical skin incision). However, there was an error in the way the variable was entered in the logistic analysis. Re-analysis with the correct coding of the variable indicates that a transverse skin incision is associated with decreased odds of wound complication compared to a vertical skin incision. [ABSTRACT FROM AUTHOR]

Background: Multiple studies have demonstrated an association between maternal obesity and postoperative complications, but there is a dearth of information about the impact of obesity on intraoperative complications.Objective: To estimate the association between maternal obesity at delivery and major intraoperative complications during cesarean delivery (CD).Methods: This is a secondary analysis of the deidentified Maternal-Fetal Medicine Unit Cesarean Registry of women with singleton pregnancies. Maternal body mass index (BMI) at delivery was categorized as BMI 18.5 to 29.9 kg/m2, BMI 30 to 39.9 kg/m2, BMI 40 to 49.9 kg/m2, and BMI ≥ 50 kg/m2. The primary outcome, any intraoperative complication, was defined as having at least 1 major intraoperative complication, including perioperative blood transfusion, intraoperative injury (bowel, bladder, ureteral injury; broad ligament hematoma), atony requiring surgical intervention, repeat laparotomy, and hysterectomy. Log-binomial models were used to estimate risk ratios of intraoperative complication in 2 models: model 1 adjusting for maternal race, and preterm delivery <37 weeks; and model 2 adjusting for confounders in Model 1 as well as emergency CD, and type of skin incision.Results: A total of 51,218 women underwent CD; 38% had BMI 18.5 to 29.9 kg/m2, 47% BMI 30 to 39.9 kg/m2, 12% BMI 40 to 49.9 kg/m2 and 3% BMI ≥ 50 kg/m2. Having at least 1 intraoperative complication was uncommon (3.4%): 3.8% for BMI 18.5 to 29.9 kg/m2, 3.2% BMI 30 to 39.9 kg/m2, 2.6% BMI 40 to 49.9 kg/m2 and 4.3% BMI ≥ 50 kg/m2 (P < .001). In the fully adjusted model 2, women with BMI 40 to 49.9 kg/m2 had a lower risk of any intraoperative complication (adjusted risk ratio [ARR], 0.76; 95% confidence interval [CI], 0.64 to 0.89) compared with women with BMI 18.5 to 29.9 kg/m2. Women with BMI 30 to 39.9 kg/m2 (ARR, 0.93; 95% CI, 0.84 to 1.03) had a similar risk of any intraoperative complication compared with nonobese women. Among super obese women, there was evidence of effect modification by emergency CD. Compared with nonobese women, neither super obese women undergoing nonemergency CD (ARR, 1.13; 95% CI, 0.84 to 1.52) nor those undergoing emergency CD (ARR, 0.59; 95% CI, 0.32 to 1.10) had an increased risk of intraoperative complication.Conclusion: In contrast to the risk for postcesarean complications, the risk of intraoperative complication does not appear to be increased in obese women, even among those with super obesity. [ABSTRACT FROM AUTHOR]

Background: Both short and prolonged sleep duration have been linked to impaired glucose metabolism. Sleep patterns change during pregnancy, but prospective data are limited on their relation to gestational diabetes.Objective: We sought to prospectively examine the trimester-specific (first and second trimester) association between typical sleep duration in pregnancy and subsequent risk of gestational diabetes, as well as the influence of compensatory daytime napping on this association.Study Design: In the prospective, multiracial Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singleton Cohort, 2581 pregnant women reported their typical sleep duration and napping frequency in the first and second trimesters. Diagnosis of gestational diabetes (n = 107; 4.1%) was based on medical records review. Adjusted relative risks with 95% confidence intervals for gestational diabetes were estimated with Poisson regression, adjusting for demographics, prepregnancy body mass index, and other risk factors.Results: From the first and second trimester, sleep duration and napping frequency declined. Sleeping duration in the second but not first trimester was significantly related to risk of gestational diabetes. The association between second-trimester sleep and gestational diabetes differed by prepregnancy obesity status (P for interaction = .04). Among nonobese but not obese women, both sleeping >8-9 hours or <8-9 hours were significantly related to risk of gestational diabetes: 5-6 hours (adjusted relative risk, 2.52; 95% confidence interval, 1.27-4.99); 7 hours (adjusted relative risk, 2.01; 95% confidence interval, 1.09-3.68); or ≥10 hours (adjusted relative risk, 2.17; 95% confidence interval, 1.01-4.67). Significant effect modification by napping frequency was also observed in the second trimester (P for interaction = .03). Significant and positive association between reduced sleep (5-7 hours) and gestational diabetes was observed among women napping rarely/never (adjusted relative risk, 2.48; 95% confidence interval, 1.20-5.13), whereas no comparable associations were observed among women napping most/sometimes.Conclusion: Our data suggest a U-shaped association between sleep duration and gestational diabetes, and that napping and prepregnancy obesity status may modify this association. [ABSTRACT FROM AUTHOR]

Background: Cell-free DNA screen failures or "no calls" occur in 1-12% of samples and are frustrating for both clinician and patient. The rate of "no calls" has been shown to have an inverse relationship with gestational age. Recent studies have shown an increased risk for "no calls" among obese women.Objective: We sought to determine the optimal gestational age for cell-free DNA among obese women.Study Design: We performed a retrospective cohort study of women who underwent cell-free DNA at a single tertiary care center from 2011 through 2016. Adjusted odds ratios with 95% confidence intervals for a "no call" were determined for each weight class and compared to normal-weight women. The predicted probability of a "no call" with 95% confidence intervals were determined for each week of gestation for normal-weight and obese women and compared.Results: Among 2385 patients meeting inclusion criteria, 105 (4.4%) had a "no call". Compared to normal-weight women, the adjusted odds ratio of a "no call" increased with increasing weight class from overweight to obesity class III (respectively: adjusted odds ratio, 2.31; 95% confidence interval, 1.21-4.42 to adjusted odds ratio, 8.55; 95% confidence interval, 4.16-17.56). A cut point at 21 weeks was identified for obesity class II/III women at which there is no longer a significant difference in the probability of a "no call" for obese women compared to normal weight women. From 8-16 weeks, there is a 4.5% reduction in the probability of a "no call" for obesity class II/III women (respectively: 14.9%; 95% confidence interval, 8.95-20.78 and 10.4%; 95% confidence interval, 7.20-13.61; Ptrend < .01).Conclusion: The cut point of 21 weeks for optimal sampling of cell-free DNA limits reproductive choices. However, a progressive fall in the probability of a "no call" with advancing gestational age suggests that delaying cell-free DNA for obese women is a reasonable strategy to reduce the probability of a "no call". [ABSTRACT FROM AUTHOR]