Medicine and Health Sciences Commons^™

Quality Improvement Project: Compliance Of Antenatal Testing In Patients With Class Iii Obesity, Isabella L. Sciacca, Timothy Kremer, Nicole Tenzel

North Texas Research Forum 2024

The prevalence of obesity in women of reproductive age (20 to 39) in the US is 39.7%. It has been estimated that one-quarter of pregnancy complications are attributable to maternal obesity. Comprehensive prenatal care is imperative to achieving positive health outcomes. This quality improvement (QI) initiative aimed to improve antenatal fetal surveillance rates in patients with class III obesity. Evidence based interventions to test fetal wellbeing were implemented and examined over a 7 month time period to evaluate physician compliance of the standard of care for antenatal surveillance starting at 34 weeks gestation. Following implementation of this initiative, compliance with …

Assessing The Impact Of Pregnancy And Birth Factors On The Maternal And Infant Microbiota, Kait F. Al, Laura Allen, Samantha Bedell, Jeremy P. Burton, Barbra De Vrijer

Obstetrics & Gynaecology Publications

Background: The microbiota acquired at birth is known to play an intimate role in later life health and disease and has been shown to be affected by the mode of birth. There has been recent interest in microbiota correction by maternal vaginal seeding in Cesarean section-born infants; however, the safety of this practice has been debated. The aim of this study was to assess how other factors, such as timing of sampling, maternal obesity, vaginal Group B Streptococcus colonization (GBS), and antibiotic exposure, affect the maternal and infant microbiota.

Methods: Maternal vaginal and saliva samples were collected at three time …

Fast Track Protocol In Bariatric Surgery, Magdy Mahmoud Moustafa, Mohamed Hassan El-Kasser, Hossam El-Din Abd El-Latif Habib

Al-Azhar International Medical Journal

Background: Overweight and obese are linked to a significant increase in the type2 DM, Hypertension, Cardiovascular disease, NASH, Gallbladder diseases, sleep apnea syndrome, arthritis, several tumors, and GERD. Weight loss surgery is referred to as bariatric surgery. The four most popular bariatric surgical methods are adjustable gastric banding (AGB), gastric bypass, sleeve gastrectomy (SG) (5), and sleeve gastrectomy with sleeve irradiation (SASI). A Fast Track Pathway is a multidisciplinary technique to improve postoperative recovery and decrease morbidity by decreasing surgical stress and its repercussions. Stress-Free surgery Aim: Evaluating applications of a Fast Track Protocol in bariatric surgery in order to …

Expression And Localization Of Nrf2/Keap1 Signalling Pathway Genes In Mouse Preimplantation Embryos Exposed To Free Fatty Acids., Grace Dionne, Michele D. Calder, Dean H Betts, Basim Abu Rafea, Andrew J Watson

Obstetrics & Gynaecology Publications

Obese women experience greater incidence of infertility, with reproductive tracts exposing preimplantation embryos to elevated free fatty acids (FFA) such as palmitic acid (PA) and oleic acid (OA). PA treatment impairs mouse preimplantation development in vitro, while OA co-treatment rescues blastocyst development of PA treated embryos. In the present study, we investigated the effects of PA and OA treatment on NRF2/Keap1 localization, and relative antioxidant enzyme (Glutathione peroxidase; Gpx1, Catalase; Cat, Superoxide dismutase; Sod1 and γ-Glutamylcysteine ligase catalytic unit; Gclc) mRNA levels, during in vitro mouse preimplantation embryo development. Female mice were superovulated, mated, and embryos cultured in the presence …

The Relationship Between Anti-Müllerian Hormone, Body Mass Index And Weight Loss: A Review Of The Literature, Jacqueline Kloos, Rachel Weinerman

Student Scholarship

Anti-Müllerian hormone (AMH) is commonly used as a proxy for ovarian reserve due to its secretion by antral follicles. It is considered a metric for prediction of ovarian response to certain assisted reproduction therapies. As obesity has a negative impact on fertility, it is important to establish whether obesity-induced hormonal changes influence AMH levels, if and how weight loss affects AMH, and if that influence represents altered reproductive function. The aim of this study was to review the existing literature on the effects of body mass index and weight loss on AMH levels. A PubMed literature keyword search with relevant …

The Impact Of Obesity And Adipokines On Breast And Gynecologic Malignancies, Surabhi Tewari, Roberto Vargas, Ofer Reizes

Faculty Scholarship

The link between obesity and multiple disease comorbidities is well established. In 2003, Calle and colleagues presented the relationship between obesity and several cancer types, including breast, ovarian, and endometrial malignancies. Nearly, 20% of cancer-related deaths in females can be accounted for by obesity. Identifying obesity as a risk factor for cancer led to a focus on the role of fat-secreted cytokines, known as adipokines, on carcinogenesis and tumor progression. Early studies indicated that the adipokine leptin increases cell proliferation, invasion, and inhibition of apoptosis in multiple cancer types. As a greater appreciation of the obesity–cancer link has amassed, we …

Dietary Blueberry And Soluble Fiber Improve Serum Antioxidant And Adipokine Biomarkers And Lipid Peroxidation In Pregnant Women With Obesity And At Risk For Gestational Diabetes, Arpita Basu, Jeannette Crew, Jeffrey L. Ebersole, Jefferson W. Kinney, Arnold M. Salazar, Petar Planinic, James M. Alexander

Kinesiology and Nutrition Sciences Faculty Publications

Pregnancies affected by obesity are at high risk for developing metabolic complications with oxidative stress and adipocyte dysfunction contributing to the underlying pathologies. Few studies have examined the role of dietary interventions, especially those involving antioxidants including polyphenolic flavonoids found in fruits and vegetables on these pathologies in high-risk pregnant women. We conducted an 18 gestation-week randomized controlled trial to examine the effects of a dietary intervention comprising of whole blueberries and soluble fiber vs. control (standard prenatal care) on biomarkers of oxidative stress/antioxidant status and adipocyte and hormonal functions in pregnant women with obesity (n = 34). Serum samples …

Effects Of Maternal Obesity And Gestational Diabetes Mellitus On The Placenta: Current Knowledge And Targets For Therapeutic Interventions, Samantha Bedell, Janine Hutson, Barbra De Vrijer, Genevieve Eastabrook

Obstetrics & Gynaecology Publications

Obesity and gestational diabetes mellitus (GDM) are becoming more common among pregnant women worldwide and are individually associated with a number of placenta-mediated obstetric complications, including preeclampsia, macrosomia, intrauterine growth restriction and stillbirth. The placenta serves several functions throughout pregnancy and is the main exchange site for the transfer of nutrients and gas from mother to fetus. In pregnancies complicated by maternal obesity or GDM, the placenta is exposed to environmental changes, such as increased inflammation and oxidative stress, dyslipidemia, and altered hormone levels. These changes can affect placental development and function and lead to abnormal fetal growth and development …

Association Between Prepregnancy Obesity And Health Behaviors, Adverse Conditions, And Birth Outcomes In South Dakota, Lily Sanderson

Electronic Theses and Dissertations

Introduction: Prepregnancy obesity is associated with an increased risk for various adverse outcomes for mother and fetus. These adverse associations exist within the realms of preconception health, prenatal health, birth outcomes, and postnatal health.
Methods: This retrospective cohort study used data from the South Dakota Pregnancy Risk Assessment Monitoring System (SD PRAMS) survey, which is an ongoing statebased surveillance system of maternal behaviors, attitudes, and experiences before, during, and shortly after pregnancy. The 2017 and 2018 SD PRAMS sampled a total of 3,805 mothers who were randomly selected from birth certificate records to be representative of all South Dakota women …

Maternal Obesity Reduces Placental Autophagy Marker Expression In Uncomplicated Pregnancies, Matthew Cohen, Emily Guo, Aidan Pucchio, Barbra De Vrijer, Trevor G Shepherd, Genevieve Eastabrook

Obstetrics & Gynaecology Publications

AIM: Obesity has been associated with changes in autophagy and its increasing prevalence among pregnant women is implicated in higher rates of placental-mediated complications of pregnancy such as pre-eclampsia and intrauterine growth restriction. Autophagy is involved in normal placentation, thus changes in autophagy may lead to impaired placental function and development. The aim of this study was to investigate the connection between obesity and autophagy in the placenta in otherwise uncomplicated pregnancies.

METHODS: Immunohistochemistry and western blot analysis were done on placental and omental samples from obese (body mass index [BMI] ≥30 kg/m

RESULTS: As pre-pregnancy BMI increased, there was …

Labour Progression In Obese Women: Are Women With Increased Body Mass Index Having Unnecessary Cesarean Sections?, Caroline Shenouda, Aloka Wijesooriya, Amanda Toufeili, Michael R Miller, Debbie Penava, Barbra De Vrijer

Obstetrics & Gynaecology Publications

OBJECTIVE: This study sought to determine whether obese pregnant women undergo cesarean sections without an adequate trial of labour. This may affect future birth and pregnancy outcomes.

METHODS: A retrospective analysis was done on 526 parturients at Victoria Hospital in London, Ontario. Women were categorized according to parity and pre-pregnancy body mass index (BMI; normal weight, BMI 18.5-24.9 kg/m

RESULTS: Obese class II and III primiparous women required an additional 1.62 and 2.67 hours (P = 0.012), respectively, to reach a dilation of 10 cm compared with their normal weight counterparts; obese class II and III multiparous women required an …

Prediction Of Neonatal Birthweight Associated With Maternal Obesity And Diabetes, Laura Gleason, Rebekah Mccurdy, Md, Mph

Phase 1

Introduction: To design a model that will predict neonatal birth weight within obese mothers by diabetic status.

Methods: A secondary data analysis of an RCT (NCT 02909582) was utilized to create a neonatal birth weight prediction model. Women (n=325) with a BMI > 35 kg/m2 from a tertiary academic institution, 2016 – 2019, were included to estimate the risk of large for gestational age (LGA) infants and neonatal birth weight based on maternal prepregnancy BMI and diabetic status. LGA was defined as an infant birth weight > 90th percentile. Analysis included Chi-square, t-test, multivariate logistic and linear regression.

Results: Mean birthweight did …

Colostrum And Mature Breast Milk Analysis Of Serum Irisin And Sterol Regulatory Element-Binding Proteins-1c In Gestational Diabetes Mellitus, Syeda Sadia Fatima, Erum Khalid, Asma Akbar Ladak, Syed Adnan Ali

Department of Biological & Biomedical Sciences

Background: We aimed to evaluate irisin and SREBP-1c levels in serum, colostrum and mature breast milk in women with and without gestational diabetes (GDM); and to relate them with maternal glucose, lipid profile and weight status of babies.
Methods: GDM positive women (n = 33) and normal glucose tolerant women (NGT) (n = 33) were recruited. Maternal blood samples were collected at 28th week of gestation and later at 6-week post-partum while breast milk samples of the lactating mothers were collected within 72 hours of birth (colostrum) and at 6 weeks post-partum (mature milk). Irisin and SREBP-1c levels were analyzed …

Influence Of Body Mass Index And Polycystic Ovarian Syndrome On Icsi/Ivf Treatment Outcomes: A Study Conducted In Pakistani Women, Rehana Rehman, Rozina Mustafa, Rabiya Ali, Saeeda Shaharyar, Faiza Alam

Department of Biological & Biomedical Sciences

Background: Obesity may establish a crucial barrier for effective fertility treatment in polycystic ovary syndrome (PCOS) females.
Objective: To compare results of intra-cytoplasmic sperm injection (ICSI) in females with and without polycystic ovarian syndrome and further appraise the effect of obesity in PCOS females.
Materials and methods: A cross-sectional study from June 2015 to July 2016 included non-PCOS and PCOS (recognized by Rotterdam criteria) females who underwent ICSI. The PCOS were further stratified into non-obese and Obese according to the South Asian criteria for body mass index. Results were categorized on the basis of beta-human chorionic gonadotropin (β-hCG) and transvaginal …

Prevalence Of Overweight And Obesity Based On The Body Mass Index; A Cross-Sectional Study In Alkharj, Saudi Arabia, Sameer Al-Ghamdi, Mamdouh M. Shubair, Abdulrahman Aldiab, Jamaan M. Al-Zahrani, Khaled K. Aldossari, Mowafa Househ, Shanila Nooruddin, Hira Abdul Razzak, Ashraf El-Metwally

Department of Paediatrics and Child Health

Background: Obesity and overweight are accompanied with several different chronic diseases. Overweight and obesity can be measured by using body mass index (BMI) and is also used widely as an index of relative adiposity among any population. The aim of the study is to evaluate the prevalence of overweight and obesity among general population in Al-Kharj, Saudi Arabia.
Methods: Cross-sectional analysis was undertaken from a representative sample (N = 1019) of the Al Kharj population. Anthropometric measurements including the waist circumference (in centimeters), height (in meters), and weight (in kilograms) of the subjects were undertaken by means of standard apparatus. …

Stop The Stigma! Eliminating Implicit And Explicit Bias Toward Adult Obese Women Receiving Gynecological Care: A Quality Improvement Project To Cultivate Empathy And Increase Knowledge Of Best Practices, Mary Ellen Burke

Doctor of Nursing Practice (DNP) Projects

Background: Increased weight carries significant health risks, yet obese individuals face stigma, implicit and explicit bias by health care providers that affects quality of care and increases health care avoidance. Obese women may delay or avoid gynecological care due to fear of stigma, inadequate equipment and embarrassment about their weight. Review of Literature: In the United States, 70.7% of adults, almost three quarters of the adult population are overweight or obese. Purpose: The purpose of this quality improvement project was to improve the quality of care and empathy toward obese women by health care providers in an OB/GYN practice through …

The Effects Of Pre-Pregnancy Tobacco Use On Food Cravings And Weight Gain In Pregnancy, Lauren E. Blau

Legacy Theses & Dissertations (2009 - 2024)

Smoking cessation is associated with greater frequency of food cravings, even when controlling for body mass index. Recent studies have indicated similarities between obese women and women who smoke tobacco in mood states and food craving frequency. This is consistent with the common substrate hypothesis, which postulates that shared neural pathways mediate craving across multiple domains, and could explain why it is common for women attempting to quit smoking to gain weight. Smoking cessation prior to pregnancy is strongly encouraged due to the adverse effects of tobacco use on the developing fetus. Studies have shown that women who quit smoking …

Circulating Early- And Mid-Pregnancy Micrornas And Risk Of Gestational Diabetes., Pandora L Wander, Edward J Boyko, Karin Hevner, Viraj J Parikh, Mahlet G Tadesse, Tanya K Sorensen, Michelle A Williams, Daniel A Enquobahrie

Articles, Abstracts, and Reports

AIMS: Epigenetic regulators, including microRNAs (miRNAs), are implicated in type 2 diabetes, but evidence linking circulating miRNAs in pregnancy and risk of gestational diabetes (GDM) is sparse. Potential modifiers, including pre-pregnancy overweight/obesity and offspring sex, are unexamined. We hypothesized that circulating levels of early-mid-pregnancy (range 7-23weeks of gestation) candidate miRNAs are related to subsequent development of GDM. We also hypothesized that miRNA-GDM associations might vary by pre-pregnancy body-mass index (ppBMI) or offspring sex.

METHODS: In a case-control analysis (36GDM cases/80 controls) from the Omega study, a prospective cohort study of pregnancy complications, we measured early-mid-pregnancy plasma levels of 10miRNAs chosen …

Clinical Significance Of A False Positive Glucose Challenge Test In Patients With A High Body Mass Index, A Borja, M Moretti, Nisha Lakhi

NYMC Faculty Publications

OBJECTIVE: To determine if there is an increased maternal or neonatal morbidity in overweight and obese patients with a false positive glucose challenge test (GCT). METHODS: Patients with a body mass index (BMI) >/=25.0 at registration were included in this prospective 36-month study. The study cohort consisted of patients with a false positive (FP) GCT, with two comparison cohorts: those with a (1) screen negative (SN) GCT result and (2) true positive (TP) GCT result. Risks were reported as odd ratios with 95% confidence intervals, with a P/=4000 g in the FP cohort, but this fell short of reaching statistical …

Effect Of Body Mass Index On Outcome Of Labour Induction, Farheen Yousuf, Tahira Naru, Sana Sheikh

Department of Obstetrics & Gynaecology

The retrospective study to explore the adverse effect of obesity on pregnancy and labour was conducted at Aga Khan University Hospital, Karachi, Pakistan, and comprised data of all patients booked between 12-14 weeks and required induction of labour from January 1 to December 31, 2012. Women were grouped into two body mass index categories: normal weight (23 kg/m2). Obesity increased the risk of development of gestational hypertension and diabetes. Therefore obese women were more likely to be induced due to medical indication whether primiparous or multiparous adjusted odds ratio =2.89(95% confidence interval 1.29-6.48) and 2.77 (95% confidence interval 1.07-7.19) respectively. …

Effect Of Metformin On Body Mass Index In Adolescent Females With Polycystic Ovary Syndrome, Alissa Briggs, Mandakini Sadhir, Maya Todd, Hatim A. Omar

Pediatrics Faculty Publications

Polycystic ovary syndrome (PCOS) is often associated with obesity, insulin resistance, irregular menstrual periods and pelvic pain. Treatment involves hormonal methods for regulation of menstrual cycle, lifestyle changes and metformin for improving insulin resistance and weight. The aim of our study was to compare changes in body mass index (BMI) of adolescent female with PCOS treated with metformin as compared to lifestyle modification only. Participants: Adolescent and young adult females aged I0-25 years diagnosed with PCOS seen for at least two visits for at least one year on the same treatment. Based on treatment plan, participants were categorized as metformin …

Bringing An Evidence-Based Nutrition And Exercise Lifestyle Intervention Program (Nelip) For Obese Pregnant Women Into Clinical Practice, Samantha Langstaff

Electronic Thesis and Dissertation Repository

One purpose was to identify the need for specialized care (My Clinic) for women with a pre-pregnancy body mass index (BMI) of ≥ 35 kg/m^2.. Women receiving My Clinic care were compared to a matched cohort control group (perinatal database, N=47). My Clinic care significantly reduced rates of macrosomia (5% vs 28%, p=0.02) and small birth weight babies (0% vs 6%, p=0.00) compared to perinatal database.

The second purpose was to test the efficacy of a Nutrition and Exercise Lifestyle Intervention Program (NELIP) in this clinical setting to prevent excessive weight gain, macrosmia, small birth weight …

Proyecto Mama: A Lifestyle Intervention In Overweight And Obese Hispanic Women: A Randomised Controlled Trial--Study Protocol, Lisa Chasan-Taber, Bess H. Marcus, Milagros C. Rosal, Katherine L. Tucker, Sheri J. Hartman, Penelope S. Pekow, Edward J. Stanek Iii, Barry Braun, Caren G. Solomon, Joanne Manson, Sarah L. Goff, Glenn Markenson

Sarah L. Goff MD

BACKGROUND: The proportion of women entering pregnancy overweight or obese has been rising and, in turn, is associated with adverse maternal and fetal outcomes. Gestational weight gain (GWG) exceeding Institute of Medicine (IOM) guidelines further increases health risks and has been independently associated with postpartum weight retention. Hispanic women are disproportionately affected by overweight and obesity, but have had limited access to interventions that promote healthy lifestyles due to cultural, socioeconomic, and language barriers. Therefore, the overall goal of this randomized controlled trial is to test the efficacy of a culturally and linguistically modified, individually-tailored lifestyle intervention to reduce excess …

Risk Of Early & Late Obstetric Complications In Women With Ivf- Conceived Pregnancies And Polycystic Ovary Syndrome (Pcos), N. A. Bagegni, J. Blaine, Bradley J. Van Voorhis, Anuja Dokras

Bradley J Van Voorhis

There is conflicting evidence on the association between PCOS and early and late obstetric complications. It is unclear if the reported risks are independent of BMI, preexisting hypertension and diabetes. We performed a retrospective chart review to examine the risk of early and late obstetrical complications after IVF in women with PCOS (n=130) compared to controls (n=130). The miscarriage rate was 17.7% in PCOS women and 15.4% in controls. PCOS was not associated with miscarriage independent of age and BMI. The prevalence of gestational DM (GDM) was similar in both groups (12% PCOS versus 11% controls). BMI was independently associated …

Fetal And Neonatal Exposure To Nicotine Augments Hepatic Fatty Acid Synthesis In Rat Offspring Long-Term, Noelle L. Ma

Electronic Thesis and Dissertation Repository

While nicotine replacement therapy (NRT) is presumed to be a safer alternative to smoking in pregnancy, the long-term consequences in offspring are still largely unknown. Animal studies now suggest that maternal nicotine exposure during pregnancy and lactation (MNE-PL) leads to a wide variety of adverse outcomes for the offspring, including increased adiposity. The focus of this study was to investigate how MNE-PL in rats may lead to liver dysfunction long-term in offspring through alterations in gene expression and epigenetic modifications. Postnatal day 180 (PND180) offspring exposed to nicotine during pregnancy and lactation (1mg/kg/day) exhibited increased circulating and hepatic triglycerides concomitant …

Obstetric Outcomes After In Vitro Fertilization In Obese And Morbidly Obese Women., Anuja Dokras, Lindsey Baredziak, Jill Blaine, Craig Syrop, Bradley Van Voorhis, Amy Sparks

Amy E.T. Sparks

OBJECTIVE: In addition to numerous health detriments caused by obesity, fertility and pregnancy success may also be compromised. The aims of this study were to compare the effects of obesity and morbid obesity on in vitro fertilization (IVF) outcomes. We also investigated the effects of obesity on obstetric outcomes after IVF treatment. METHODS: Retrospective study of women less than 38 years of age during their first fresh IVF cycle (January 1995 to April 2005). RESULTS: A total of 1,293 women were included in the study, with 236 obese women (body mass index [BMI] = 30-39.9) and 79 morbidly obese women …

Obesity As An Epidemic: Causes, Morbidities And Reproductive Performance, E. Hakan Duran

Eyup Hakan Duran

Obesity is an epidemic causing significant morbidity and mortality in United States. It is facilitated by many factors including sedentary life style, abundance of food, and unhealthy dietary habits. This review aims to briefly address causes and conditions associated with obesity, with a special emphasis on reproductive performance for Obstetricians and Gynecologists.

Obesity And Insulin Resistance But Not Hyperandrogenism Mediates Vascular Dysfunction In Women With Polycystic Ovary Syndrome., Anuja Dokras, Dinesh Jagasia, Michelle Maifeld, Christine Sinkey, Bradley Van Voorhis, William Haynes

Bradley J Van Voorhis

OBJECTIVE: Polycystic ovary syndrome (PCOS) is associated with biochemical evidence of early atherosclerosis; however, data regarding vascular function are controversial. We hypothesized that resistance vessel function (mediated by the endothelium or smooth muscle) would be impaired in women with PCOS and aimed to determine the contribution of hyperandrogenism, obesity, or insulin resistance to vascular dysfunction.

DESIGN: Prospective study.

SETTING: University practice.

PATIENT(S): Women with PCOS (n = 24) and age/weight-matched controls (n = 22).

INTERVENTION(S): Vascular function was assessed by measuring forearm vasodilatation in response to both endothelium-dependent (acetylcholine/bradykinin) and endothelium-independent dilators (nitroprusside/verapamil).

MAIN OUTCOME MEASURE(S): Resistance vessel function.

RESULT(S): …

Obstetric Outcomes After In Vitro Fertilization In Obese And Morbidly Obese Women., Anuja Dokras, Lindsey Baredziak, Jill Blaine, Craig Syrop, Bradley Van Voorhis, Amy Sparks

Bradley J Van Voorhis

OBJECTIVE: In addition to numerous health detriments caused by obesity, fertility and pregnancy success may also be compromised. The aims of this study were to compare the effects of obesity and morbid obesity on in vitro fertilization (IVF) outcomes. We also investigated the effects of obesity on obstetric outcomes after IVF treatment. METHODS: Retrospective study of women less than 38 years of age during their first fresh IVF cycle (January 1995 to April 2005). RESULTS: A total of 1,293 women were included in the study, with 236 obese women (body mass index [BMI] = 30-39.9) and 79 morbidly obese women …

Risk Of Early & Late Obstetric Complications In Women With Ivf- Conceived Pregnancies And Polycystic Ovary Syndrome (Pcos), N. A. Bagegni, J. Blaine, Bradley J. Van Voorhis, Anuja Dokras

Bradley J Van Voorhis

There is conflicting evidence on the association between PCOS and early and late obstetric complications. It is unclear if the reported risks are independent of BMI, preexisting hypertension and diabetes. We performed a retrospective chart review to examine the risk of early and late obstetrical complications after IVF in women with PCOS (n=130) compared to controls (n=130). The miscarriage rate was 17.7% in PCOS women and 15.4% in controls. PCOS was not associated with miscarriage independent of age and BMI. The prevalence of gestational DM (GDM) was similar in both groups (12% PCOS versus 11% controls). BMI was independently associated …