Noninvasive prenatal testing and maternal obesity: A review.

Noninvasive prenatal testing (NIPT) has become a popular screening test for the most common fetal aneuploidies. The performance of NIPT is affected by several factors including maternal obesity, which results in a greater rate of no-calls for obese pregnant women. Guidelines regarding NIPT in prenatal screening have been published, but with few and divergent recommendations on the issue. We aimed to review the medical literature, guidelines from scientific societies and information material from commercial NIPT providers on no-calls and maternal obesity. We systematically identified medical literature and guidelines from scientific societies using the database MEDLINE. Information material from commercial NIPT providers was found via a systematic search on Google.com. Nine medical studies investigating the association between maternal obesity and NIPT no-calls were included. They all showed the same trend: increasing no-call rate with increasing maternal obesity. The no-call rate ranged from 0% to 4.2% for women with body mass index (BMI) 18.5-24.9 and from 5.4% to 70.1% for women BMI ≥40. We identified 17 scientific societies with guidelines and 13 commercial NIPT providers. All were checked for information material on no-calls and maternal obesity. To allow comparison, all guidelines were examined to answer the same three predefined questions. Of the 17 included scientific societies, 13 (76.5%) mentioned the association between maternal obesity and NIPT no-calls, two (11.8%) specified weight limits and three (17.6%) advised against NIPT for severely obese pregnant women. None of the 13 commercial NIPT providers provided specific recommendations, but four (30.8%) cite maternal obesity as a potential cause for a no-call. Because of the increasing number of patients in this group, we advocate updated recommendations to guide decision making in prenatal screening for obese pregnant women.

The effects of maternal obesity during gestation and lactation and orange juice intake on the metabolic profile of male offspring exposed to control and obesogenic diets and breast cancer risk of female offspring / A obesidade materna durante a gestação e lactação e o consumo do suco de laranja: efeitos nos parâmetros metabólicos da prole masculina exposta a dieta controle e obesogênica e programação do risco do câncer de mama da prole feminina de camundongos

Obesity is a worldwide public health problem and the main risk factor for a number of chronic diseases. Breast cancer is another worrisome disease: it is the leading cause of cancer amongst women and has an elevated mortality rate. Approximately 30 years ago, Barker and Trichopoulos suggested that cardiovascular disease and breast cancer, respectively, may be originated in utero. In subsequent years, studies proved both hypotheses correct. Understanding how in-utero environment can affect development of obesity and breast cancer in adulthood is key for preventing these diseases. Nutrition during gestation and lactation is considered a modifiable factor to impact in-utero environment. Orange juice (OJ) is an excellent source of bioactive compounds, including vitamin C and flavonoids, and reports suggests that intake of orange juice minimizes damaging effects of obesity. The objective of this thesis was to evaluate the effects of maternal obesity during gestation and lactation and OJ intake on (a) metabolic profile of male offspring exposed to control and obesogenic diets and (b) breast cancer risk of female offspring. Four-week-old C57BL/6 female mice were assigned into three groups: control- fed a control diet and water ad libitum, obese- fed obesogenic diet and water ad libitum and obese+OJ- fed obesogenic diet and OJ. After three weeks on the diet, females were mated to control males. Male offspring from each group were weaned into control or obesogenic diets for 21 weeks. Female offspring was either euthanized for evaluation of mammary gland development or submitted to a chemically induced breast carcinogenesis protocol. Parameters to assess metabolism (as body composition and adipose tissue expression of obesity-related genes), breast cancer risk (as epithelial elongation and number of terminal end buds) and tumorigenesis (incidence, latency and multiplicity of mammary tumors) were collected. ANOVA followed by Tukey or Fischer´s LSD test were used to investigate differences between groups and a p<0.05 was considered significant. Male offspring of obese mothers fed control diet presented increased glucose concentrations and expression of F4/80 and interleukin-6 compared to control offspring. Male offspring of obese+OJ mothers fed a control diet presented expression of F4/80 and interleukin-6 similar to control offspring. Male offspring to control mothers fed obesogenic diet presented increased glucose concentrations and epidydimal fat tissue compared to offspring of obese mothers. Offspring to obese+OJ mothers presented increased expression of leptin and tumor necrosis factor-α. Female offspring of obese mothers had decreased terminal end buds and increased latency of first tumor and OJ intake decreased epithelial elongation compared to offspring of control/obese mothers. Maternal obesity had greater impact in offspring exposed to control than obesogenic environment. OJ intake by mothers helped with harmful effects induced by maternal obesity on male offspring fed control diet. Control offspring exposed to obesogenic diet presented worse metabolic profile than offspring from obese mothers. In this particular case, OJ was not beneficial to male offspring. Whereas obesity induced by a high-fat high-sugar diet presented a somewhat protective effect on breast cancer risk, OJ further protected offspring of obese mothers

A obesidade é um problema de saúde pública e o principal fator de risco para uma série de doenças crônicas. O câncer de mama é outra doença preocupante: é a principal causa de câncer entre as mulheres e tem elevada taxa de mortalidade. Há 30 anos, Barker e Trichopoulos sugeriram que a doença cardiovascular e o câncer de mama, respectivamente, podem ser originados no útero. Nos anos seguintes essas hipóteses foram confirmadas. Compreender como o ambiente intrauterino pode afetar o desenvolvimento da obesidade e o câncer de mama na idade adulta, portanto, é fundamental para prevenir essas doenças. O estado nutricional e a nutrição durante a gestação e lactação são considerados fatores modificáveis e que pode influenciar o ambiente intrauterino. O suco de laranja (SL) é uma excelente fonte de compostos bioativos, incluindo vitamina C e flavonoides, e estudos sugerem que a ingestão de suco de laranja pode minimizar os efeitos deletérios da obesidade. O objetivo dessa tese foi de avaliar os efeitos da obesidade materna durante a gestação e lactação e a ingestão de SL no (a) perfil metabólico da prole masculinas expostos à dietas controle e obesogênica e (b) risco de câncer de mama da prole feminina. Camundongos fêmeas C57BL/6, com quatro semanas de idade, foram distribuídos em três grupos: controle - alimentados com uma dieta de controle e água ad libitum, obesosalimentados com dieta obesogênica e água ad libitum e obesos+SL- alimentados com dieta obesogênica e SL. Após três semanas na dieta, as fêmeas foram acasaladas com machos controle. A prole masculina de cada grupo foi desmamada e alimentadas com dieta obesogênica ou controle por 21 semanas. A prole feminina foi eutanasiada para a avaliação do desenvolvimento da glândula mamária ou submetida a um protocolo de carcinogênese mamária quimicamente induzida. Parâmetros para avaliar o metabolismo (como a composição corporal e expressão de genes relacionados à obesidade do tecido adiposo), risco de câncer de mama (como desenvolvimento epitelial e número de terminal end buds) e tumorigênese (incidência, latência e multiplicidade dos tumores mamários) foram coletados. Para investigar diferença estatística entre os grupos foi realizada ANOVA, seguida pelo teste de Tukey ou LSD de Fischer e um p<0,05 foi considerado significante. A prole masculina de mães obesas alimentadas com dieta de controle apresentou aumento das concentrações de glicose e aumento das expressões de F4/80 e interleucina-6 em relação a prole controle. A prole masculina de mães obesas+SL alimentadas com dieta controle apresentou expressão de F4/80 e interleucina-6 similar à da prole de controle. A prole masculina de mães controle e alimentada com dieta obesogênica apresentou aumento das concentrações de glicose e aumento do tecido adiposo epididimal em comparação à prole de mães obesas. A prole de mães obesas+SL apresentou maior expressão de leptina e TNF-α. A prole feminina de mães obesas apresentou redução do número de terminal end buds e aumento da latência para o aparecimento do primeiro tumor. O consumo de SL diminuiu o desenvolvimento epitelial comparado as proles de mães controles e obesas. A obesidade materna teve maior impacto na prole masculina exposta a dieta controle do que na obesogênica. A ingestão materna de SL ajudou com efeitos danosos induzidos pela obesidade materna na prole masculina alimentada com dieta controle. A prole de fêmeas controles e alimentada com dieta obesogênica apresentou perfil metabólico pior que a prole das mães obesas. Neste caso, o SL não foi benéfico para a prole masculina. A obesidade materna induzida por uma dieta rica em banha e açúcares apresentou discreto efeito protetor no risco de câncer de mama, o SL acentuou esta proteção

Maternal obesity classes, preterm and post-term birth: a retrospective analysis of 479,864 births in England.

BACKGROUND: Preterm (< 37 weeks gestation) and post-term birth (≥42 weeks gestation) are associated with increased morbidity and mortality for mother and infant. Obesity (body mass index (BMI) ≥30 kg/m2) is increasing in women of reproductive age. Maternal obesity has been associated with adverse pregnancy outcomes including preterm and post-term birth. However, the effect sizes vary according to the subgroups of both maternal BMI and gestational age considered. The aim of this retrospective analysis was to determine the association between maternal obesity classes and gestational age at delivery. METHODS: A secondary data analysis of 13 maternity units in England with information on 479,864 singleton live births between 1990 and 2007. BMI categories were: underweight (< 18.5 kg/m2), recommended weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obesity classes I (30.0-34.9 kg/m2), II (35.0-39.9 kg/m2), IIIa (40-49.9 kg/m2) and IIIb (≥50 kg/m2). Gestational age at delivery categories were: Gestational age at delivery (weeks): extreme preterm (20-27), very preterm (28-31), moderately preterm (32-36), early term (37, 38), full term (39-40), late term (41) and post-term (≥42). The adjusted odds of births in each gestational age category (compared to full-term birth), according to maternal BMI categories were estimated using multinomial logistic regression. Missing data were estimated using multiple imputation with chained equations. RESULTS: There was a J-shaped association between the absolute risk of extreme, very and moderate preterm birth and BMI category, with the greatest effect size for extreme preterm. The absolute risk of post-term birth increased monotonically as BMI category increased. The largest effect sizes were observed for class IIIb obesity and extreme preterm birth (adjusted OR 2.80, 95% CI 1.31-5.98). CONCLUSION: Women with class IIIb obesity have the greatest risks for inadequate gestational age. Combining obesity classes does not accurately represent risks for many women as it overestimates the risk of all preterm and post-term categories for women with class I obesity, and underestimates the risk for women in all other obesity classes.

Impact of obesity class on trial of labor after cesarean success: does pre-pregnancy or at-delivery obesity status matter?

OBJECTIVE: To investigate whether pre-pregnancy versus at delivery obesity status impacts TOLAC success rates in a modern cohort. STUDY DESIGN: A retrospective cohort study of women undergoing TOLAC at a single institution from May 2007 to April 2016. Women were divided into four groups (not obese; class I, II, and III obesity) by pre-pregnancy and at delivery weight class. We investigated associations between obesity status at both time points and TOLAC success rates. RESULT: Six hundred and fourteen women underwent TOLAC; 444 (72.3%) had successful VBACs. We found no difference in rate of VBAC success across the four groups, both prior to pregnancy (p = 0.91) and at delivery (p = 0.75). We found no differences in secondary perinatal morbidity outcomes. CONCLUSION: We found no difference in TOLAC success rates stratified by obesity class. Properly counseling patients on TOLACs can lower rates of morbidity in women with high-risk conditions and comorbidities.