Association Between Maternal Body Mass Index and Fetal Acidosis in Term Twin Pregnancies: A Retrospective Cohort Study.

OBJECTIVES: Given the increased risk of fetal acidosis in singleton neonates born to pregnant people with an elevated BMI, our objective was to evaluate the association between pre-pregnancy/first-trimester BMI and fetal acidosis among term twin pregnancies. METHODS: Retrospective study of pregnant people with twin gestation and their term infants admitted to our centre between 2014 and 2019. Using a generalized estimating equation, the association between maternal BMI and fetal acidosis was determined using odds ratios (ORs) with 95% CIs. A two-sided P < 0.05 was considered significant. RESULTS: A total of 275 pregnant people and 550 infants were analyzed. The number (%) of pregnancies in each BMI class were 10 (4%) underweight, 155 (56%) normal weight, 66 (24%) overweight, 22 (8%) class I, 9 (3%) class II, and 13 (5%) class III. The prevalence of maternal diabetes and hypertension was highest in class III (31%) and class II (44%), respectively. Fetal acidosis was diagnosed in 35 (6%) infants. After adjusting for confounders (maternal age, diabetes, and hypertension), infants born to those with elevated BMI did not have increased odds of fetal acidosis compared to those born to underweight and normal weight group (OR 1.29; 95% CI 0.38-4.41 for class I, P = 0.67 and OR 2.80; 95% CI 0.62-12.62 for the combined classes II and III, P = 0.18). CONCLUSIONS: Maternal BMI was not associated with fetal acidosis in term twin pregnancies. Further research is required to corroborate study findings due to small sample size.

Hypertensive disorders of pregnancy and long-term cardiovascular health: FIGO Best Practice Advice.

Hypertensive disorders of pregnancy (HDP) are the most common causes of maternal and perinatal morbidity and mortality. They are responsible for 16% of maternal deaths in high-income countries and approximately 25% in low- and middle-income countries. The impact of HDP can be lifelong as they are a recognized risk factor for future cardiovascular disease. During pregnancy, the cardiovascular system undergoes significant adaptive changes that ensure adequate uteroplacental blood flow and exchange of oxygen and nutrients to nurture and accommodate the developing fetus. Failure to achieve normal cardiovascular adaptation is associated with the development of HDP. Hemodynamic alterations in women with a history of HDP can persist for years and predispose to long-term cardiovascular morbidity and mortality. Therefore, pregnancy and the postpartum period are an opportunity to identify women with underlying, often unrecognized, cardiovascular risk factors. It is important to develop strategies with lifestyle and therapeutic interventions to reduce the risk of future cardiovascular disease in those who have a history of HDP.

The challenges of obesity for fertility: A FIGO literature review.

Obesity has been linked to infertility through several mechanisms, including at a molecular level. Those living with obesity face additional barriers to accessing fertility treatments and achieving a successful pregnancy, which can contribute to their economic and psychosocial stressors. There is scope to further improve care for people living with obesity and infertility with empathy, via a multidisciplinary approach.

Management of obesity across women's life course: FIGO Best Practice Advice.

Obesity is a chronic, progressive, relapsing, and treatable multifactorial, neurobehavioral disease. According to the World Health Organization, obesity affects 15% of women and has long-term effects on women's health. The focus of care in patients with obesity should be on optimizing health outcomes rather than on weight loss. Appropriate and common language, considering cultural sensitivity and trauma-informed care, is needed to discuss obesity. Pregnancy is a time of significant physiological change. Pre-, ante-, and postpartum clinical encounters provide opportunities for health optimization for parents with obesity in terms of, but not limited to, fertility and breastfeeding. Pre-existing conditions may also be identified and managed. Beyond pregnancy, women with obesity are at an increased risk for gastrointestinal and liver diseases, impaired kidney function, obstructive sleep apnea, and venous thromboembolism. Gynecological and reproductive health of women living with obesity cannot be dismissed, with accommodations needed for preventive health screenings and consideration of increased risk for gynecologic malignancies. Mental wellness, specifically depression, should be screened and managed appropriately. Obesity is a complex condition and is increasing in prevalence with failure of public health interventions to achieve significant decrease. Future research efforts should focus on interprofessional care and discovering effective interventions for health optimization.

Using FIGO Nutrition Checklist counselling in pregnancy: A review to support healthcare professionals.

The period before and during pregnancy is increasingly recognized as an important stage for addressing malnutrition. This can help to reduce the risk of noncommunicable diseases in mothers and passage of risk to their infants. The FIGO Nutrition Checklist is a tool designed to address these issues. The checklist contains questions on specific dietary requirements, body mass index, diet quality, and micronutrients. Through answering these questions, awareness is generated, potential risks are identified, and information is collected that can inform health-promoting conversations between women and their healthcare professionals. The tool can be used across a range of health settings, regions, and life stages. The aim of this review is to summarize nutritional recommendations related to the FIGO Nutrition Checklist to support healthcare providers using it in practice. Included is a selection of global dietary recommendations for each of the components of the checklist and practical insights from countries that have used it. Implementation of the FIGO Nutrition Checklist will help identify potential nutritional deficiencies in women so that they can be addressed by healthcare providers. This has potential longstanding benefits for mothers and their children, across generations.

Pregnancy as an opportunity to prevent type 2 diabetes mellitus: FIGO Best Practice Advice.

Gestational diabetes (GDM) impacts approximately 17 million pregnancies worldwide. Women with a history of GDM have an 8-10-fold higher risk of developing type 2 diabetes and a 2-fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken. Considering the increasing global rates of type 2 diabetes and CVD in women, it is essential to utilize pregnancy as an opportunity to identify women at risk and initiate preventive intervention. This article reviews existing clinical guidelines for postpartum identification and management of women with previous GDM and identifies key recommendations for the prevention and/or delayed progression to type 2 diabetes for global clinical practice.

Obstetrical Outcomes of Head and Neck (Nonthyroid) Cancers: A 27-Year Retrospective Series and Literature Review.

Objective To describe the clinical presentation and obstetrical outcomes of nonthyroid head and neck cancers (HNCs), and to review literature on this rare condition in pregnancy. Study Design Pregnant women with nonthyroid HNC were identified retrospectively from 1990 to 2017. Maternal, neonatal, pregnancy, and demographic data were collected. A review of the literature from January 1980 to May 2018 was performed. Results Over the 27-year time period, 16 women with history of nonthyroid HNC were identified (9 diagnosed during and 7 diagnosed before current pregnancy). The cases were analyzed in detail and the most updated review of management of each type of HNC was provided. Conclusions HNCs are rare with diagnosis and management challenges during pregnancy. In this series, the cases diagnosed and managed previously to pregnancy presented better perinatal outcomes than the cases presented during pregnancy. The maternal outcomes appeared similar for HNC diagnosed before or after pregnancy.

A clinical carepath for obese pregnant women: a pragmatic pilot cluster randomized controlled trial.

Objectives: Obese women are at increased risks for complications during pregnancy, birth, and in their infants. Although guidelines have been established for the clinical care of obese pregnant women, management is sometimes suboptimal. Our goal was to determine the feasibility of implementing and testing a clinical carepath for obese pregnant women compared to standard care, in a pilot cluster randomized controlled trial (RCT). Methods: A pragmatic pilot cluster RCT was conducted, randomly allocating eight clinics to the carepath or standard care for obese pregnant women. Women were eligible if they had a pre-pregnancy body mass index (BMI) of ≥30 kg/m2 and a viable singleton <21 weeks. The primary outcomes were the feasibility of conducting a full-scale cluster RCT (defined as >80%: randomization of clinics, use in eligible women, and completeness of follow-up) and of the intervention (defined as >80%: compliance with each step in the carepath and recommendation of the carepath by clinicians to a colleague). Results: All eight approached clinics agreed to participate and were randomized. Half of the intervention clinics used the carepath, resulting in <80% uptake of eligible women. High follow-up (99.5%) was achieved, in 188 of 189 women. The carepath was feasible for numerous guideline-directed recommendations for screening, but less so for counseling topics. When the carepath was used in the majority of women, all clinicians, most of whom were midwives, reported they would recommend it to a colleague. The intervention group had significantly higher overall adherence to the guideline recommendations compared to control (relative risk: 1.71, 95% confidence interval: 1.57-1.87). Conclusions: In this pragmatic pilot cluster RCT, a guideline-directed clinical carepath improved some aspects of care of obese pregnant women and was recommended by clinicians, particularly midwives. A cluster RCT may not be feasible in a mix of obstetric and midwifery clinics, but may be feasible in midwifery clinics.

Breast Cancer in Pregnancy: A Retrospective Cohort Study.

Gestational breast cancer (GBC) is the second most commonly occurring malignancy affecting pregnant women. Management is complex due to potential foetal risks in the setting of maternal treatment. We report on the maternal, foetal, short-term neonatal and placental histopathologic findings of a retrospective cohort of pregnant women with either pre-gestational (group 1) or GBC (group 2) from a tertiary-level maternity care centre. Of the 69 women identified over 12 years, there were 47 in group 1 and 22 in group 2. Demographics, stage of breast cancer at diagnosis were similar in the 2 groups. Women with GBC (group 2) were more likely to receive surgery and chemotherapy or surgery alone as compared to those in group 1. No women with GBC received radiation during pregnancy, but 2 received this treatment postpartum. With regard to pregnancy outcomes, induction of labour was more common in women with GBC, as was preterm birth. Most preterm birth in women with GBC was late preterm, iatrogenic in nature to facilitate postpartum treatment. We conclude comparable pregnancy outcomes for women with GBC as compared to those with pregestational breast cancer.

Restrictive lung disease in pregnancy.

Restrictive lung disease is uncommon in pregnancy. We reviewed 15 pregnancies in 12 women with restrictive disease due to kyphoscoliosis, neuromuscular disease, or parenchymal lung disease. Median FVC was 40% predicted, and six women (50%) had an FVC < 1.0 L. In the 14 pregnancies in which at least two spirometry readings were available, FVC increased in three pregnancies, decreased in three, and remained stable in eight, with maximal changes of 0.4 L. Three women required supplemental oxygen, and one woman with neuromuscular disease required noninvasive ventilation. Premature delivery occurred in nine pregnancies (60%), and 10 deliveries (67%) were by cesarean section. Neuraxial anesthesia was used in 10 of 15 deliveries but was limited in the others by difficult spinal anatomy. There was no maternal or neonatal mortality. Women with restrictive lung disease tolerate pregnancy reasonably well, but many have premature delivery. A multidisciplinary approach is essential, with monitoring of spirometry and oxygenation and planning for labor and delivery.

Challenges of pelvic imaging in obese women.

Obesity is a major global health concern affecting all ages, socioeconomic groups, and countries. Although men have higher rates of overweight, women have higher rates of obesity. In the United States, more than 60% of women are overweight or obese, with slightly more than one-third considered frankly obese. Obesity is a major risk factor for noncommunicable diseases such as diabetes mellitus, cardiovascular disease, hypertension, stroke, and specific cancers. Obesity is associated with increased mortality for all cancers, with the highest death rates occurring in the heaviest women. Obesity can contribute to missed diagnoses, nondiagnostic results of imaging studies, imaging examination cancellation because of weight or girth restrictions, scheduling of inappropriate examinations, and increased radiation dose exposure. The utility of the clinical examination is often limited in the obese woman, which results in an even greater reliance on imaging; however, the obese woman may experience a lowered quality of and less access to medical imaging. Recognition of equipment limitations, imaging artifacts, optimization techniques, and appropriateness of modality choices is critical to providing good patient care to this health-challenged group. The clinical indication, the patient's weight, and the body diameters are three key factors to consider when choosing the most appropriate examination. Familiarity with the optimization of imaging techniques across all modalities is important to convert potentially suboptimal examinations into diagnostic-quality studies. The aim of this review is to identify key areas in which obesity affects the imaging care of women with pelvic conditions and to outline strategies to address these areas.

Outcomes of obstetric hospitalizations among women with inflammatory bowel disease in the United States.

BACKGROUND & AIMS: Pregnant women with Crohn's disease (CD) or ulcerative colitis (UC) are at increased risk of adverse outcomes compared with pregnant women without these disorders. We estimated the occurrence of pregnancies in women with CD and UC in the United States and compared outcomes between these patients and the non-inflammatory bowel disease (IBD) obstetric population. METHODS: By using the 2005 Nationwide Inpatient Sample, we estimated the number of obstetric hospitalizations, deliveries, and Cesarean deliveries in women with CD, UC, and those without IBD. Outcomes included prevalences of Cesarean delivery, venous thromboembolism (VTE), blood transfusion, and malnutrition. RESULTS: Of an estimated 4.21 million deliveries, 2372 and 1368 occurred in women with CD and UC, respectively. Compared with the non-IBD population, adjusted odds of Cesarean delivery were higher in women with CD (adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.44-2.04) and UC (aOR, 1.29; 95% CI, 1.01-1.66). The risk of VTE was substantially higher in women with CD (aOR, 6.12; 95% CI, 2.91-12.9) and UC (aOR, 8.44; 95% CI, 3.71-19.2) vs the non-IBD population. Blood transfusions occurred more frequently in women with CD (aOR, 2.82; 95% CI, 1.51-5.26), whereas protein-calorie malnutrition occurred more frequently in women with CD (aOR, 20.0; 95% CI, 8.8-45.4) or UC (aOR, 60.8; 95% CI, 28.2-131.0). CONCLUSIONS: Adverse pregnancy and maternal outcomes occur more frequently in women with IBD. Measures should be undertaken to reduce maternal complications such as VTE and malnutrition in women with these disorders.