Maternal obesity, duration of labor and the role of leptin


Book Description

Background: The prevalence of obesity substantially increases in pregnant women. Maternal obesity is associated with adverse maternal and neonatal outcomes. The increased risk for cesarean section present in obese women has been related to potential impaired uterine contractility. The mechanism that underlies this theory is not clear. In vitro studies have shown that leptin, produced by adipose tissue and the placenta, exerts an inhibitory effect on myometrial contractility. The aim of this thesis was to evaluate the labor process in relation to maternal body mass index (BMI) and the clinical role of leptin in this process. Material and Methods: Studies I-IV are cohort studies. The first two studies analyze the association between labor duration and maternal BMI based on data from the Perinatal Revision South register and the Swedish Pregnancy Register. Study I included 63,829 nulliparous women with a spontaneous onset of labor between 1995 and 2009. Study II included 15,259 nulliparous women with induced labor between 2014 and 2017. In study III, the maternal leptin levels during and after pregnancy were analyzed in 343 obese women with respect to their obesity class (I-III) and degree of gestational weight gain (GWG). In study IV, the association between the maternal leptin levels measured in active labor and duration of the active phase of labor was analyzed in 914 women. Results: The duration of spontaneous labor significantly increased with an increasing maternal BMI; however, the duration of the pushing phase was inversely related to BMI. Time in induced labor increased with maternal BMI; however, the differences between the BMI categories were more pronounced in the latent phase than the active phase. Leptin levels were higher in women with obesity class III than women with class I during and after pregnancy. The degree of GWG in obese women was not associated with maternal leptin. No significant association between maternal leptin and the duration of the active phase of labor was identified in the adjusted analyses. Conclusions: Nulliparous obese women have a higher risk for a prolonged duration of spontaneous and induced labor. This is important to consider prior to diagnosing labor arrest that results in a cesarean delivery. As maternal leptin levels are increased with the degree of obesity during pregnancy, future research on the association of high maternal leptin levels and the duration of labor is warranted.




Maternal Obesity, Duration of Labor and the Role of Leptin


Book Description

Background: The prevalence of obesity substantially increases in pregnant women. Maternal obesity is associated with adverse maternal and neonatal outcomes. The increased risk for cesarean section present in obese women has been related to potential impaired uterine contractility. The mechanism that underlies this theory is not clear. In vitro studies have shown that leptin, produced by adipose tissue and the placenta, exerts an inhibitory effect on myometrial contractility. The aim of this thesis was to evaluate the labor process in relation to maternal body mass index (BMI) and the clinical role of leptin in this process. Material and Methods : Studies I-IV are cohort studies. The first two studies analyze the association between labor duration and maternal BMI based on data from the Perinatal Revision South register and the Swedish Pregnancy Register. Study I included 63,829 nulliparous women with a spontaneous onset of labor between 1995 and 2009. Study II included 15,259 nulliparous women with induced labor between 2014 and 2017. In study III, the maternal leptin levels during and after pregnancy were analyzed in 343 obese women with respect to their obesity class (I-III) and degree of gestational weight gain (GWG). In study IV, the association between the maternal leptin levels measured in active labor and duration of the active phase of labor was analyzed in 914 women. Results: The duration of spontaneous labor significantly increased with an increasing maternal BMI; however, the duration of the pushing phase was inversely related to BMI. Time in induced labor increased with maternal BMI; however, the differences between the BMI categories were more pronounced in the latent phase than the active phase. Leptin levels were higher in women with obesity class III than women with class I during and after pregnancy. The degree of GWG in obese women was not associated with maternal leptin. No significant association between maternal leptin and the duration of the active phase of labor was identified in the adjusted analyses. Conclusions: Nulliparous obese women have a higher risk for a prolonged duration of spontaneous and induced labor. This is important to consider prior to diagnosing labor arrest that results in a cesarean delivery. As maternal leptin levels are increased with the degree of obesity during pregnancy, future research on the association of high maternal leptin levels and the duration of labor is warranted.




Focus on Obesity Research


Book Description

Far from a sign of healthy prosperity and contentment, overweight and obesity are now considered high risk factors for a wide range of diseases including early death and disability, heart disease, diabetes, reproductive problems, cancer, breathing problems and arthritis. Obesity, now at epidemic levels in many countries, is defined as an excessively high amount of body fat or adipose tissue in relation to lean body mass. The amount of body fat (or adiposity) includes concern for both the distribution of fat throughout the body and the size of the adipose tissue deposits. This book includes within its scope the causal connection of obesity to diseases as well as the prevention and treatment of obesity. Leading-edge scientific research from throughout the world is presented.




Maternal-Fetal Nutrition During Pregnancy and Lactation


Book Description

With the aim to improve clinicians' understanding of the important effects nutrition can have on maternal health and fetal and neonatal development, Maternal-Fetal Nutrition During Pregnancy and Lactation defines the nutritional requirements with regard to the stage of development and growth, placing scientific developments into clinical context.




Regulation of Body Weight


Book Description

The fact that about 30-40% of the adults in the Western world are overweight or obese testifies to the frequency of the disturbances in body weight regulation. Scientists have established that caloric intake, macronutrient composition of the diet, basal and resting metabolic rate, thermic response to food, energy expenditure associated with movement and physical activity, and preferential storage of the surplus of calories as fat or lean tissues are critical determinants of energy balance and body weight. While much has been learned, the field is poised for major advances with the advent of a variety of imaging techniques, progress in quantitative and molecular genetics, use of transgenic rodent models and of breeding experiments with informative inbred strains, availability of stable isotopes for metabolic and behavioral studies, and a growing number of useful experimental animal and human models. This volume takes an integrative approach to obesity. It is structured around four major topics: (1) the animal and human models currently available for the study of body weight regulation with their strengths and limitations, (2) the molecular and genetic basis of the regulation of body weight, (3) the metabolic and physiological mechanisms involved, and (4) the behavioral and social determinants. The 13 background papers provide a critical overview of the present knowledge base while the group reports summarize the extensive deliberations of 38 international experts. Particular emphasis has been given to promising research areas and on the advances needed to ensure a better understanding of the biological and behavioral mechanisms of the regulation of body weight, with a particular emphasis on overweight and obesity.




Weight Gain During Pregnancy


Book Description

As women of childbearing age have become heavier, the trade-off between maternal and child health created by variation in gestational weight gain has become more difficult to reconcile. Weight Gain During Pregnancy responds to the need for a reexamination of the 1990 Institute of Medicine guidelines for weight gain during pregnancy. It builds on the conceptual framework that underscored the 1990 weight gain guidelines and addresses the need to update them through a comprehensive review of the literature and independent analyses of existing databases. The book explores relationships between weight gain during pregnancy and a variety of factors (e.g., the mother's weight and height before pregnancy) and places this in the context of the health of the infant and the mother, presenting specific, updated target ranges for weight gain during pregnancy and guidelines for proper measurement. New features of this book include a specific range of recommended gain for obese women. Weight Gain During Pregnancy is intended to assist practitioners who care for women of childbearing age, policy makers, educators, researchers, and the pregnant women themselves to understand the role of gestational weight gain and to provide them with the tools needed to promote optimal pregnancy outcomes.




Obesity and Obstetrics


Book Description

Obesity and Obstetrics, Second Edition, brings together experts to examine the issues and challenges of obesity and obstetrics, also discussing how obesity affects fertility, reproduction and pregnancy. Beginning with the worldwide epidemic of obesity, chapters then go on to review obesity and hyperglycemia of pregnancy, management of labor, interventions to improve care during pregnancy, and long-term impact of maternal obesity. Provides an essential reference on the significant risk of complications during pregnancy, including early pregnancy loss, recurrent miscarriage and fetal developmental abnormalities Builds foundational knowledge on how maternal obesity predisposes offspring to obesity, highlighting that the prevention of childhood obesity begins during pregnancy Assembles critically evaluated chapters focused on obesity and obstetrics to meet the practical needs of obstetricians, endocrinologists and general practitioners




Benirschke's Pathology of the Human Placenta


Book Description

This book had its beginning in 1967 when Shirley G. Driscoll and Kurt Benirschke wrote in English the volume on placental pathology for the Henke-Lubarsch, the noted German Handbook of Pathology. There seemed to be a need for wider distribution of the text and it was reprinted by Springer Verlag, New York, essentially the only book available devoted just to the human placenta. Dr. Benirschke authored 5 subsequent editions in collaboration with Peter Kaufmann, Rebecca Baergen and Graham Burton in 1990 (2nd edition), 1995 (3rd edition), 2000 (4th edition), 2006 (5th edition) and 2012 (6th edition). In the early editions, the most important material was in a larger font than the extensive review of exceptions and the discussion in the literature. Since 1967, many other shorter placenta books have been published in English, French and German. None of these have included the breadth of discussion or the voluminous references which includes details of many historic articles, not readily available. Interest in the placenta has wildly expanded over the intervening 50+ years with the vast majority of Pathologists, Obstetricians and Pediatricians recognizing its value. In addition, there are now quite a few new journals, societies and meetings devoted to the placenta in both clinical and research areas. The interest extends into areas of study well beyond the realm of anatomic pathology. The 7th edition will, of necessity, differ from the prior editions which Dr. Benirschke wrote largely himself at first, and later with the help of the above noted co-authors. It will now be an international multi-authored book with nearly 40 contributors revising one or more chapters. The explosion of new information as necessitating some reordering of chapters and adding completely new chapters including Chapters 31 and 32, “Innovations in Placental Pathology” and “Imaging in Placental Pathology”. Dr. Burton’s section has been extensively edited, as well. The editors gave the new authors considerable latitude in how to write the new and/or edited chapters. Many of the revised chapters retain much of Dr. Benirschke’s anecdotal information as well as the voluminous references. Others are more modern in their approach. All contain substantial new references and current information. It is our hope that Benirschke’s Pathology of the Human Placenta will remain as a mainstay reference in placental pathology. It aims to help readers gain a broad understanding of how placental architecture is shaped during normal development, with a view to appreciating how this may be perturbed in complications of pregnancy.




Molecular Mechanisms of Signal Transduction


Book Description

This book contains overviews of topics that have been discussed. It includes contributions from leading experts in the field on small GTPases, protein kinases and transcription factors. A particular focus was the influence of oxygen radicals on signalling processes. It also contains the contribution of scientists early in their career, who have made an exccellent contribution to the institute."




Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults


Book Description

Of evidence-based recommendations -- Introduction -- Overweight and obesity: background -- Examination of randomized controlled trial evidence -- Treatment guidelines -- Summary of recommendations -- Future research.