Nj Sebire

Maternal obesity and pregnancy outcome: a study of 287 213 pregnancies in London

OBJECTIVE: To examine the maternal and foetal risks of adverse pregnancy outcome in relation to maternal obesity, expressed as body mass index (BMI, kg/m2) in a large unselected geographical population.DESIGN: Retrospective analysis of data from a validated maternity database system which includes all but one of the maternity units in the North West Thames Region. A comparison of pregnancy outcomes was made on the basis of maternal BMI at booking.SUBJECTS: A total of 287u2005213 completed singleton pregnancies were studied including 176 923 (61.6%) normal weight (BMI 20–24.9), 79 014 (27.5%) moderately obese (BMI 25–29.9) and 31 276 (10.9%) very obese (BMI≥30) women.MEASUREMENTS: Ante-natal complications, intervention in labour, maternal morbidity and neonatal outcome were examined and data presented as raw frequencies and adjusted odds ratios with 99% confidence intervals following logistic regression analysis to account for confounding variables.RESULTS: Compared to women with normal BMI, the following outcomes were significantly more common in obese pregnant women (odds ratio (99% confidence interval) for BMI 25–30 and BMI≥30 respectively): gestational diabetes mellitus (1.68 (1.53–1.84), 3.6 (3.25–3.98)); proteinuric pre-eclampsia (1.44 (1.28–1.62), 2.14 (1.85–2.47)); induction of labour (2.14 (1.85–2.47), 1.70 (1.64–1.76)); delivery by emergency caesarian section (1.30 (1.25–1.34), 1.83 (1.74–1.93)); postpartum haemorrhage (1.16 (1.12–1.21), 1.39 (1.32–1.46)); genital tract infection (1.24 (1.09–1.41), 1.30 (1.07–1.56)); urinary tract infection (1.17 (1.04–1.33), 1.39 (1.18–1.63)); wound infection (1.27 (1.09–1.48), 2.24 (1.91–2.64)); birthweight above the 90th centile (1.57 (1.50–1.64), 2.36 (2.23–2.50)), and intrauterine death (1.10 (0.94–1.28), 1.40 (1.14–1.71)). However, delivery before 32 weeks gestation (0.73 (0.65–0.82), 0.81 (0.69–0.95)) and breastfeeding at discharge (0.86 (0.84–0.88), 0.58 (0.56–0.60)) were significantly less likely in the overweight groups. In all cases, increasing maternal BMI was associated with increased magnitude of risk.CONCLUSION: Maternal obesity carries significant risks for the mother and foetus. The risk increases with the degree of obesity and persists after accounting for other confounding demographic factors. The basis of many of the complications is likely to be related to the altered metabolic state associated with morbid obesity.

Raised maternal serum inhibin A concentration at 10 to 14 weeks of gestation is associated with pre‐eclampsia

Maternal serum inhibin A and free β human chorionic gonadotrophin (β‐hCG) were measured in 759 chromosomally normal, pregnant women at 10–14 weeks of gestation. There were nine who subsequently developed pre‐eclampsia and in these women the maternal serum inhibin A concentration was significantly higher than in the normotensive controls.

Maternal serum alpha‐fetoprotein in fetal neural tube and abdominal wall defects at 10 to 14 weeks of gestation

Maternal serum alpha‐fetoprotein concentration was determined in nine pregnancies with fetal anencephaly, seven with exomphalos containing liver, two with spina bifida and 100 normal controls at 10 to 14 weeks of gestation. The median alpha‐fetoprotein in the group with fetal anencephaly and exomphalos was significantly higher than in normal fetuses but the sensitivity of this test is likely to be only about 30% for a false positive rate of 5%.