Search

Objective The purpose of the study was to examine the relationship between mode of delivery in primigravidas and visceral fat measured in early pregnancy. Study design We enrolled women at their convenience between July 2008 and April 2010 after a sonogram confirmed they had an ongoing singleton pregnancy in the first trimester. Visceral fat was measured using bioelectrical impedence analysis (Tanita 180, Tokyo). Clinical and demographic details were recorded at the first antenatal visit and at delivery. Visceral fat centiles had previously been derived for a white European population.1 Results Out of 1008 primigravidas enrolled, 973 subsequently delivered in the hospital a baby weighing 500 g or more. In women with a visceral fat >7, there was an increase in the mean age, mean birth weight and rate of induction of labour (p=0.01). There was a higher rate of emergency caesarean section in women with a visceral fat measurement >7 compared to women with a visceral fat measurement ≤7 (p=0.01). This was due to higher rates of fetal distress (p=0.01) in labour. Conclusion Our study showed an association between increased caesarean section rates and maternal obesity based on the visceral fat measurement in the first trimester.

Background Hypertension in pregnancy is an important cause of pregnancy complications for both mother and baby in about 8% of pregnancies. Epidemiological reviews have reported an association between pre-eclampsia and maternal obesity, based on a body mass index (BMI) > 29.9 kg/m2. However, BMI measurements were usually based on self-reporting of maternal weight and height which has been shown to be inaccurate, particularly in pregnancy and in obese women. The purpose of this prospective cross-sectional study was to compare the incidence of pre-eclampsia in the different WHO BMI categories in both primigravidas and multigravidas. Methods Women were recruited at their convenience in the first trimester. Height and weight were measured digitally and BMI calculated. Pre-eclampsia was defined as hypertension (a systolic blood pressure of ≥140 mm Hg and/or a diastolic blood pressure of ≥90 mm Hg) measured on at least two separate occasions at least 6 h apart with proteinuria (≥300 mg over 24 h) after 20 weeks. Results Of the 2230 women, the mean age was 28.2 years and mean parity was 1.0. The mean gestation at recruitment was 11.2 weeks and the mean BMI was 25.6 kg/m2. The incidence of obesity was 17.4%. The incidence of pre-eclampsia analysed by BMI category is show in table 1. In both primigravidas and multigravidas, there was no increase in pre-eclampsia with obesity (p=0.23, p=0.07). Conclusions When maternal BMI is calculated accurately in early pregnancy, contrary to previous reports, there is no association between maternal obesity and pre-eclampsia.

Changes in maternal blood pressure are seen in normal pregnancy. Mean arterial pressure falls until the end of the second trimester and then rises again to prepregnancy levels in the late third trimester. The aetiology of hypertensive disease of pregnancy remains elusive but may involve changes in the arterial vessel wall. We investigated what changes in arterial elasticity occur during pregnancy. Subjects were recruited from the antenatal clinic at their first visit to the hospital. Using the HDI/Pulsewave CR-2000 Research Cardiovascular Profiling System, we analysed the radial artery pulse pressure waveform on 660 occasions in 100 uncomplicated pregnancies between 8 and 40 weeks gestation. Reflective and capacitive arterial compliance was calculated from the pulse pressure waveform contour using a modified Windkessel model of the circulation (electrical analogue model). Centiles for artery elasticity throughout gestation were calculated and fitted using linear mixed effect modelling appropriate to longitudinal data. We found that reflective arterial compliance changes with advancing gestation. The median reflective arterial compliance is 7.6 ml/mm Hg×100 at 16 weeks gestation rising to a peak of 7.8 ml/mm Hg×100 at 20 weeks gestation and then declining to a median value of 5.8 ml/mm Hg×100 at 40 weeks gestation. We also found that capacitive artery elasticity only changes minimally with advancing gestation with a median value of 13.3 ml/mm Hg×10 at all gestations. Changes in small artery vessel wall elasticity are reciprocal to the changes in blood pressure throughout pregnancy. The increase in elasticity seen in the second trimester may contribute to the fall in mean arterial pressure. Further study is needed to clarify the aetiology of these physiological changes.

Maternal obesity has emerged as a major public health issue however, a paucity of information regarding Body Mass Index (BMI) and body composition specifically in fathers during pregnancy. This study aims to determine the BMI and the body composition of fathers-to-be and to compare the findings with the mother-to-be during pregnancy. The authors conducted a prospective observational study in a large university teaching hospital. The authors enrolled men whose partner booked for antenatal care in the first trimester of pregnancy. The height and weight of both parents-to-be were measured digitally and BMI calculated. The body composition of the couple was analysed using bioelectrical impedance. Of 167 fathers-to-be, 14% were obese (BMI >29.9 kg/m2) compared with 16% of mothers-to-be (NS). However, 50% were overweight (BMI 25.0 – 29.9 kg/m2) compared with 26% of mothers-to-be (p Our findings show a high level of obesity in fathers-to-be, which has implications not only for the men themselves but also their families. The authors suggest that public health obesity interventions may need to be family-centred.

Maternal obesity is associated with an increase in childhood obesity, but causation remains uncertain. The authors studied the relationship between maternal and fetal body composition in the third trimester. The study was confined to Caucasian non-diabetic women with a singleton pregnancy. Weight and height were measured in the first trimester. At 28- and 37-week maternal body composition was analysed using advanced bioelectrical impedance, and fetal parameters and soft tissue measurements were measured by ultrasound. Of the 178 women, the mean body mass index was 28.2 kg/m2 and 66.7% were obese. Fetal adiposity measurements at 28-week gestation did not correlate with maternal body composition. The fetal abdominal circumference (AC) and not abdominal adiposity at 37 weeks correlated with maternal fat mass (FM). Fetal thigh adiposity at 37 weeks correlated with maternal FM. Increase in maternal arm FM and not leg FM correlated with the AC and fetal thigh adiposity measurements at 37 weeks. Fetal AC and thigh adiposity measurements are influenced by maternal obesity. This supports that the intrauterine environment predisposes the fetus to childhood obesity.

Objective The introduction of new models of care in the Irish maternity services has been recommended by both advocacy groups and strategic reports. The purpose of this study was to seek the views of women about the different models of care. Subjects and methods We surveyed women who were attending the out-patients department in early pregnancy in a large Dublin maternity hospital. Demographic and clinical details were recorded prospectively. Results Of the 501 women surveyed, 45.5% preferred to deliver in a doctor-led unit, while 42.9% preferred a midwifery-led unit. Of those 42.9%, 55% met the inclusion criteria. There was minimal demand (1.6%) for home births. Of the 8 who opted for home delivery, only 4 (0.8% overall) were suitable on clinical grounds. 70% wanted shared antenatal care between their general practitioner and either an obstetrician or midwife. Choice was influenced by whether the woman was attending for private care or not. Safety is the most important factor for women when choosing the type of maternity care they want. A private room and a desire to avoid hospitals are least important. Of women surveyed, 86% believed they had enough information to allow them to choose the model of maternity care. Conclusion We found that pregnant women in Ireland want a range of choices when it comes to models of maternity care. Their choice is strongly influenced by childbirth safety issues and least influenced by the physical surroundings for childbirth.