Impact of parental obesity on neonatal markers of inflammation and immune response.

BACKGROUND/OBJECTIVES: Maternal obesity may influence neonatal and childhood morbidities through increased inflammation and/or altered immune response. Less is known about paternal obesity. We hypothesized that excessive parental weight contributes to elevated inflammation and altered immunoglobulin (Ig) profiles in neonates. SUBJECTS/METHODS: In the Upstate KIDS Study maternal pre-pregnancy body mass index (BMI) was obtained from vital records and paternal BMI from maternal report. Biomarkers were measured from newborn dried blood spots (DBS) among neonates whose parents provided consent. Inflammatory scores were calculated by assigning one point for each of five pro-inflammatory biomarkers above the median and one point for an anti-inflammatory cytokine below the median. Linear regression models and generalized estimating equations were used to estimate mean differences (ß) and 95% confidence intervals (CI) in the inflammatory score and Ig levels by parental overweight/obesity status compared with normal weight. RESULTS: Among 2974 pregnancies, 51% were complicated by excessive maternal weight (BMI>25), 73% by excessive paternal weight and 28% by excessive gestational weight gain. Maternal BMI categories of overweight (BMI 25.0-29.9) and obese class II/III (BMI≥35) were associated with increased neonatal inflammation scores (ß=0.12, 95% CI: 0.02, 0.21; P=0.02 and ß=0.13, CI: -0.002, 0.26; P=0.05, respectively) but no increase was observed in the obese class I group (BMI 30-34.9). Mothers with class I and class II/III obesity had newborns with increased IgM levels (ß=0.11, CI: 0.04, 0.17; P=0.001 and ß=0.12, CI: 0.05, 0.19); P<0.001, respectively). Paternal groups of overweight, obese class I and obese class II/III had decreased neonatal IgM levels (ß=-0.08, CI: -0.13,-0.03, P=0.001; ß=-0.07, CI: -0.13, -0.01, P=0.029 and ß=-0.11, CI:-0.19,-0.04, P=0.003, respectively). CONCLUSIONS: Excessive maternal weight was generally associated with increased inflammation and IgM supporting previous observations of maternal obesity and immune dysregulation in offspring. The role of paternal obesity requires further study.

AANA testifies before PPRC on federal healthcare reform.

The AANA shares President Clinton's view that health system reform must center on increased patient access to care, the need for care to be provided in a cost-effective manner, and that quality of care should not be diminished. The AANA believes that CRNAs can play a critical role in health system reform because for more than a century they have provided a model of how patients can have access to high quality, cost-effective health services, specifically anesthesia services.

Budget Reconciliation Law contains single anesthesia fee cuts.

While OBRA93 will result in payment reductions for CRNAs and anesthesiologists involved in the anesthesia care team, the law also contained AANA victories. First, the anesthesia care team reductions will be phased in over several years rather than occurring immediately in 1994. Second, RAP DRGs were defeated. Third, the use of actual anesthesia time for purposes of Medicare billing was retained. Fourth, parity in payments for new physicians/new CRNAs was restored. Fifth, teaching anesthesiologists will receive the same payment for supervising two anesthesiologist residents as they do for working with two nurse anesthesia students beginning in 1994. The AANA concerns that were not addressed on OBRA93, such as the TEFRA conditions and access to clinical privileges, are not dead. They will be lobbied for again in future legislative vehicles, such as President Clinton's healthcare reform plan.