Amy O'Higgins

The relationship between gestational weight gain and fetal growth: time to take stock?

Abstract The aim of this article is to review the current evidence on gestational weight gain (GWG). Maternal obesity has emerged as one of the great challenges in modern obstetrics as it is becoming increasingly common and is associated with increased maternal and fetal complications. There has been an upsurge of interest in GWG with an emphasis on the relationship between excessive GWG and increased fetal growth. Recent recommendations from the Institute of Medicine in the USA have revised downwards the weight gain recommendations in pregnancy for obese mothers. We believe that it is time to take stock again about the advice that pregnant women are given about GWG and their lifestyle before, during, and after pregnancy. The epidemiological links between excessive GWG and aberrant fetal growth are weak, particularly in obese women. There is little evidence that intervention studies decrease excessive GWG or improve intrauterine fetal growth. Indeed, there is a potential risk that inappropriate interventions during the course of pregnancy may lead to fetal malnutrition that may have adverse clinical consequences, both in the short- and long-term. It may be more appropriate to shift the focus of attention from monitoring maternal weight to increasing physical activity levels and improving nutritional intakes.

Birth Weight and Neonatal Adiposity Prediction Using Fractional Limb Volume Obtained with 3D Ultrasound

Introduction: The objective of this investigation was to study fetal thigh volume throughout gestation and explore its correlation with birth weight and neonatal body composition. This novel technique may improve birth weight prediction and lead to improved detection rates for fetal growth restriction. Materials and Methods: Fractional thigh volume (TVol) using 3D ultrasound, fetal biometry and soft tissue thickness were studied longitudinally in 42 mother-infant pairs. The percentages of neonatal body fat, fat mass and fat-free mass were determined using air displacement plethysmography. Correlation and linear regression analyses were performed. Results: Linear regression analysis showed an association between TVol and birth weight. TVol at 33 weeks was also associated with neonatal fat-free mass. There was no correlation between TVol and neonatal fat mass. Abdominal circumference, estimated fetal weight (EFW) and EFW centile showed consistent correlations with birth weight. Thigh volume demonstrated an additional independent contribution to birth weight prediction when added to the EFW centile from the 38-week scan (p = 0.03). Conclusion: Fractional TVol performed at 33 weeks gestation is correlated with birth weight and neonatal lean body mass. This screening test may highlight those at risk of fetal growth restriction or macrosomia.

The interplay between maternal obesity and gestational diabetes mellitus

Abstract There is a strong epidemiological association between maternal obesity and gestational diabetes mellitus (GDM). Since the publication of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study on women with mild hyperglycemia in 2008, new criteria have been introduced in maternity services internationally for the diagnosis of GDM. As a result, the diagnosis of GDM may be made in one-third of obese women (n=68). The aim of this review was to examine the interplay between maternal obesity and GDM in light of the HAPO study and the subsequent revised diagnostic criteria. Obesity and GDM are important obstetric risk factors because they both are potentially modifiable. However, the new international criteria for the diagnosis of GDM have serious resource implications for maternity services provided to the large number of women attending for care in developed countries. Further consideration needs to be given as to whether obese women with mild hyperglycemia need to be referred to a multidisciplinary team antenatally if they do not require insulin treatment.

Longitudinal measurement of fetal thigh soft tissue parameters and its role in the prediction of birth weight

The aim of this study was to profile longitudinal changes in thigh muscle and fat with gestation and to determine whether thigh measurements can improve the prediction of birth weight (BW).

The relationship between unplanned pregnancy and maternal body mass index 2009–2012

Abstract Objective To analyse the relationship between unplanned pregnancy and maternal Body Mass Index (BMI). Methods A prospective case-control study of planned vs. unplanned pregnancies among women who delivered an infant weighing ≥ 500 g during the four years 2009–2012 in a large maternity hospital in Ireland. Maternal weight and height were measured at the first antenatal visit before calculation of BMI. Clinical and sociodemographic details were computerised. BMI was categorised according to the World Health Organization. The epidemiological associations were examined using logistic regression, adjusted for confounding variables. Results Between 2009 and 2012, 34,377 women were included, 31.7% (n = 10,894) reported an unplanned pregnancy and 16.6% (n = 5647) were obese. The odds ratios of unplanned pregnancy were greater among obese women compared with those of normal BMI (unadjusted Odds Ratio (OR) 1.3; 95% Confidence Interval (CI) 1.3–1.4 p < 0.001). These ratios increased with increasing BMI (mild unadjusted OR 1.3; CI 1.2–1.4 p < 0.001; moderate unadjusted OR 1.4; CI 1.2–1.6 p < 0.001; severe obesity unadjusted OR 1.7; CI 1.4–2.0 p < 0.001). The higher rate of unplanned pregnancy among obese women was associated with a lower rate of contraception usage and a higher rate of contraceptive failure. Only 37.6% (n = 2112) of obese women took preconceptional folic acid to prevent neural tube defects compared with 46.1% (n = 8176) of women with a normal BMI (p < 0.001). Conclusion Higher rates of unplanned pregnancy among obese women compared with women with a normal BMI is associated with compromised prepregnancy care in this high-risk population. Chinese Abstract 摘要： 目的 分析意外怀孕和孕妇体重指数(BMI)之间的关系。 方法 对在爱尔兰的一个大型妇产科医院里，从2009 - 2012年四年间，生产婴儿的体重≥500 g的计划内和计划外怀孕的女性，进行前瞻性病例对照研究。在计算体重指数之前的第一次产前随访时，测量孕妇的体重和身高。临床和社会人口的详细资料已用电脑处理。体重指数是根据世界卫生组织进行的分类。使用逻辑回归进行了流行病学关联调查，同时调整混杂变量。 结果 从2009年至2012年期间， 34377名女性被纳入研究。据报道， 31.7%(n=10894)的意外怀孕女性中有16.6%(n=5647)为肥胖女性。肥胖女性意外怀孕的比值比比体重指数(BMI)正常的女性意外怀孕的比值比大(未调整的比值比为1.3；95%可信区间：1.3-1.4， p < 0.001)。这些比值随着体重指数的增加而增大(轻微调整的比值比为1.3；可信区间：1.2-1.2， p < 0.001；适度调整的比值比为1.4；可信区间；1.2-1.6 ，p < 0.001；严重肥胖未经调整的比值比为1.7；可信区间；1.4-2.0 ，p < 1.4)。肥胖女性中较高的意外怀孕率与较低的避孕率及较高的避孕失败率有关。与46.1%(n=8176)的体重指数正常的女性相比，只有37.6%(n=2112) 的肥胖女性服用叶酸来预防神经管缺陷(p < 0.001)。 结论 肥胖女性意外怀孕的几率比体重指数正常的女性高，这个结论与肥胖女性放弃孕前保健有关。 关键词： 肥胖孕妇；意外怀孕；避孕

Maternal bacteremia and the Irish maternity early warning system

To assess whether introduction of the Irish maternity early warning system (IMEWS) in 2013 has improved the recording of vital signs among women with proven maternal bacteremia.

An estimation of periconceptional under-reporting of dietary energy intake

BACKGROUND The purpose of this cross-sectional study was to examine periconceptional misreporting of energy intake (EI) using the Willet food frequency questionnaire (WFFQ). METHODS Women were recruited in the first trimester. Women completed a semi-quantitative WFFQ. Maternal body composition was measured using eight-electrode bioelectrical impedance analysis. Under-reporters were those whose ratio of EI to their calculated basal metabolic rate fell below the calculated plausible threshold for their physical activity category. RESULTS The mean age was 30.1 ± 5.3 years (n = 524). The mean body mass index (BMI) was 25.4 ± 5.6 kg/m(2), and 16.6% were obese (BMI ≥ 30.0 kg/m(2)). Under-reported EI was observed in 122 women (23.3%) with no over-reporters in the sample. Under-reporters were younger (P < 0.001), less likely to have a normal BMI (P = 0.002) and more likely to be obese (P < 0.001) than plausible reporters. Under-reporters had higher percentage of body-fat and lower percentage of body fat-free mass (P < 0.001), were more likely to be at risk of relative deprivation (P = 0.001) and reported a higher percentage of EI from carbohydrate (P = 0.02) than plausible reporters. CONCLUSIONS Observed differences between under-reporters and plausible reporters suggest that the exclusion of these under-reporters represents an important potential source of bias in obesity research among women in the periconceptional period.

Fetal subcutaneous tissue measurements in pregnancy as a predictor of neonatal total body composition

The purpose of this study was to examine the relationship between prenatal measures of subcutaneous tissue as surrogate markers of fetal nutritional status and correlate them with neonatal total body composition.

Evaluation of the systemic inflammatory response syndrome criteria for the diagnosis of sepsis due to maternal bacteremia.

To examine, in the setting of maternal bacteremia, the implications for the diagnosis of maternal sepsis of customizing the systemic inflammatory response syndrome (SIRS) criteria for physiologic changes of pregnancy.

A longitudinal study of unplanned pregnancy in a maternity hospital setting

To review family planning in a cohort of women who delivered a second child within 3 years of their first.