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Objective: The purpose of this study was to assess the contribution of obesity on quality of a woman's life during pregnancy., Study Design: At the Hospital of Gynecology and Obstetrics in León, Mexico, we followed-up 220 pregnant women (110 obese and 110 nonobese) who completed the 12-item short-form health survey at the beginning and during the third trimester of pregnancy., Results: The mental component score was lower in obese than in nonobese women at the beginning of gestation and at the third trimester but increased in the entire group during pregnancy. The physical component score (PCS) decreased during pregnancy and was lower in obese than in nonobese pregnant women (43.5 vs 47.2; P = .01) at the third trimester. Baseline body mass index, weight gain, and complications during pregnancy were associated negatively with PCS (R2=0.11; P < .001 for the model)., Conclusion: Baseline body mass index, weight gain, and complications during gestation are associated negatively with PCS of quality of life.

Objective: To determine the maternal and fetal morbidity in obese pregnant women compared with non-obese pregnant women., Patients and Methods: It was carried out a case-control study. There were included 342 patients who had a body mass index previous to the pregnancy of 18.5 to 24.9 (control group) and 342 pregnant women with body mass index > 30 (group of obese women). We registered the mother and newborns' data to evaluate their morbidity. The groups were compared with Student's t test or Mann Whitney's U test for continuous data and chi-square or Fisher exact test for categorical variables., Results: We found more macrosomic newborns in the group of obese women (p = 0.003) and a higher number of caesarean sections (48.8 vs 37.4%, p = 0.003). The maternal morbidity characterized by gestational diabetes was higher in the obese ones (3.5 vs 0.58%, p = 0.015). Other variables as preterm delivery, stillbirths, malformations, admissions to the neonatal intensive care unit, as well as the development of hypertensive disorders of pregnancy were not significant., Conclusion: We found higher maternal and fetal morbidity in obese women. Therefore, these patients should be considered as carriers of high-risk pregnancies. This strategy could avoid complications associated to this group of patients.

We compared factors associated with sympathetic cardiac activity in 70 male adolescents (34 obese and 36 with appropriate weight). In fasting we measured insulin, leptin, glucose, blood pressure, and heart rate variability by power spectral analysis. Obese adolescents had higher values for systolic blood pressure, insulin, leptin, low frequency/high frequency index (LF/HF); and lower for standard deviation of all the normal RR intervals, and total power. In the multiple regression analysis, factors associated with LF/HF index were leptin and systolic blood pressure (R2 = 0.18; P = 0.004 for the model). We concluded that higher sympathetic activity in obese adolescents is related to higher leptin and systolic blood pressure levels..

Obesity has been shown to be associated with increased left ventricular mass (LVM) and heart sympathetic activity even in nonhypertensive subjects. These factors are predictors of cardiovascular morbidity and mortality independent of other traditional risk factors. We evaluated the effect of losartan and spironolactone on LVM and heart sympathetic activity in prehypertensive obese subjects. A 16-week blinded randomized trial was performed in middle-aged men selected from a Health Public program. Anthropometric and clinical variables were measured at baseline and after losartan (50 mg/day; n=25) or spironolactone (25 mg/day; n=25) treatment. Heart sympathetic activity was evaluated with 60-min electrocardiograph monitoring, and spectral analysis was carried out. LVM was measured by echocardiography according to Devereux and Reicheck's formula indexed for body height (m2.7) to account for obesity. Anthropometric variables, systolic, and diastolic blood pressure levels decreased in both groups of treatment without statisticall difference between them. Losartan increased heart rate variability (from 70.0 to 82.3 ms; P=0.01), and decreased low frequency-high frequency index (from 6.6 to 4.9; P=0.001), and LVM (from 49.2 to 45.2 g; P=0.004). In the multiple regression analysis for factors associated with reduction in LVM; treatment with losartan, and decrease in SBP were the only factors included in the model (R2=0.60; P=0.003). To conclude losartan, but not spironolactone, decreased LVM and heart sympathetic overactivity in prehypertensive obese subjects after 16 weeks of treatment. Regression on LVM was associated with reduction on SBP levels.

Background: Pathogenesis of left ventricular hypertrophy (LVH) is multifactorial, but evidence that the sympathetic system is involved in progression of cardiovascular structural alterations in hypertension is substantial. However, the relationship between heart sympathetic activity and left ventricular mass in normotensive obese subjects has not been studied., Methods: We studied 103 male normotensive subjects (53 obese and 50 non-obese). Left ventricular mass (LVM), heart sympathetic activity by 60 min electrocardiograph (EKG) monitoring, leptin, insulin, lipid profile, and blood pressure were measured., Results: Obese subjects showed higher LVM (p=0.0002), low frequency/high frequency ratio (LF/HF) (p=0.004), systolic and diastolic blood pressure (p <0.00001 for both), insulin (p=0.00001), and leptin levels (p <0.00001) than non-obese subjects. In contrast, standard deviation (SD) of all rate-rhythm (R-R) intervals (SDNN) (p=0.0002) and total power (TP) (p=0.03) were lower in obese than in non-obese subjects. In multiple regression analysis for factors associated with LVM, body mass index (BMI) (R=0.24), systolic blood pressure (R=0.22), and LF/HF (R=0.21) were the only factors included in the model (R2=0.32, p <0.0001)., Conclusions: LVM is increased in normotensive obese subjects and correlates with systolic blood pressure and heart sympathetic activity.

Background: Angiotensinogen has been proposed as a possible link between obesity and hypertension because the adipocyte produces angiotensinogen and contains the enzymes required for its conversion. Moreover, sympathetic overactivity has been reported in obese subjects. The aim of this study was to compare heart sympathetic activation and serum angiotensinogen levels in obese and non-obese normotensive subjects, their relationship, and the effect of a drug that modifies the renin-angiotensin system., Methods: Serum angiotensinogen, leptin, lipids, glucose, and insulin levels were measured and 24-h electrocardiograph monitoring was carried out in 41 (20 non-obese and 21 obese) volunteers before and after administration of 5 mg enalapril twice/day for 7 days., Results: Obese subjects had higher values than non-obese subjects for % body fat (35.1+/-4.6 vs. 30.5+/-5.2; p=0.005), triglycerides (1.93+/-0.9 vs. 1.25+/-0.7 g/L, p=0.002), insulin (114.8+/-82.5 vs. 45.9+/-22.2 pmol/L), leptin (31.4+/-20.4 vs. 14.1+/-11.2 ng/mL, p=0.002), and LF/HFn index (4.3+/-2.9 vs. 2.2+/-1.3, p<0.005). Enalapril increased angiotensinogen levels only in the non-obese group (4.2+/-3.9 vs. 9.7+/-5.4 ng/mL, p=0.001) and diminished the LF/HFn index (4.3+/-2.9 vs. 3.0+/-1.4, p=0.007) in the group of obese subjects. There was no association between angiotensinogen levels and sympathetic activity., Conclusions: Higher level of sympathetic activity was found in normotensive obese as compared with non-obese subjects. Enalapril treatment reduced heart sympathetic activity in obese subjects but did not change angiotensinogen levels.

Background: In rats leptin increases sympathetic activity, and an inhibitory effect on leptin synthesis and release has been demonstrated for the catecholamines, both in adipocyte cell cultures and in healthy experimental animals. The aim of this study was to evaluate the relationship between leptin and heart sympathetic activity as well as changes in leptin levels after the administration of drugs that modify sympathetic activity., Methods: We performed a randomized, blinded, before-after trial in 81 normotensive obese and non-obese subjects. They were studied before and after treatment with enalapril (5 mg every 12 hours) or clonidine (0.1 mg every 12 hours) for 7 days., Results: Obese subjects had higher values for percent body fat (p < 0.0005), triglycerides (p < 0.05), leptin (p < 0.0005), and low frequency/high frequency ratio at night (LF/HFn, p = 0.05). After enalapril or clonidine treatment, leptin levels were not modified. Both drugs significantly diminished the systolic and diastolic blood pressures. In the obese group, clonidine and enalapril diminished the LF/HFn ratio (p < 0.05). The LF/HF index showed a univariate correlation with body mass index, leptin, systolic blood pressure, insulin, age and triglyceride levels. In the multiple regression analysis for factors associated with the LF/HF ratio, only leptin, age and insulin were included in the model. The r2 of the model was 0.3 (p = 0.0003)., Conclusions: A higher level of heart sympathetic activity is found in normotensive obese as compared with non-obese subjects. Both clonidine and enalapril reduced heart sympathetic activity in obese subjects without a change in fasting leptin levels.