Early Pregnancy Serum Concentration of Secreted Frizzled-Related Protein 4, Secreted Frizzled-Related Protein 5, and Chemerin in Obese Women Who Develop Gestational Diabetes Mellitus

Abstract Background: The aim of this study was to evaluate whether secreted frizzled-related protein 4 (sFRP4), secreted frizzled-related protein 5 (sFRP5), and chemerin serum concentrations in early pregnancy are associated with the development of gestational diabetes mellitus (GDM) in an obese cohort. In previous studies, increased sFRP4 and chemerin, and decreased sFRP5 concentrations were associated with the development of GDM in normal and overweight women. Methods: In this exploratory case control study, sFRP4, sFRP5, and chemerin serum concentrations were determined by ELISA in 50 obese women who developed GDM and 100 uncomplicated control pregnancies. Serum samples were obtained between 15+0–18+6 weeks’ gestational age and based on a priori known associations with the development of GDM, body mass index (BMI) and maternal age were selected for adjustment in multivariate analyses. Results: In this obese cohort (median BMI 35.7 kg/m2, IQR 33.2–40.3 kg/m2), the biochemical markers showed no association with GDM: sFRP5 odds ratio (OR) 0.44 (95% confidence interval (CI) 0.01–23.18, p = 0.687), sFRP4 OR 0.55 (95% CI 0.09–3.52, p = 0.528), and chemerin OR 3.47 (95% CI 0.05–227.72, p = 0.560). Adjustment for BMI and maternal age did not influence the association. None of the markers were significantly correlated with insulin resistance (HOMA2-IR). Conclusion: No association was found between sFRP4, sFRP5, or chemerin concentration and the development of GDM in a cohort of obese pregnant women. The absence of the association may indicate that these proteins play a lesser biological role in the pathophysiology of GDM in obese women

Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis

BACKGROUND: Overweight and obesity pose a big challenge to pregnancy as they are associated with adverse maternal and perinatal outcome. Evidence of lifestyle intervention resulting in improved pregnancy outcome is conflicting. Hence the objective of this study is to determine the efficacy of antenatal dietary, activity, behaviour or lifestyle interventions in overweight and obese pregnant women to improve maternal and perinatal outcomes. METHODS: A systematic review and meta-analyses of randomised and non-randomised clinical trials following prior registration (CRD420111122 http://www.crd.york.ac.uk/PROSPERO) and PRISMA guidelines was employed. A search of the Cochrane Library, EMBASE, MEDLINE, CINAHL, Maternity and Infant care and eight other databases for studies published prior to January 2012 was undertaken. Electronic literature searches, study selection, methodology and quality appraisal were performed independently by two authors. Methodological quality of the studies was assessed according to Cochrane risk of bias tool. All appropriate randomised and non-randomised clinical trials were included while exclusions consisted of interventions in pregnant women who were not overweight or obese, had pre-existing diabetes or polycystic ovarian syndrome, and systematic reviews. Maternal outcome measures, including maternal gestational weight gain, gestational diabetes and Caesarean section, were documented. Fetal outcomes, including large for gestational age and macrosomia (birth weight > 4 kg), were also documented. RESULTS: Thirteen randomised and six non-randomised clinical trials were identified and included in the meta-analysis. The evidence suggests antenatal dietary and lifestyle intervention in obese pregnant women reduces maternal pregnancy weight gain (10 randomised clinical trials; n = 1228; -2.21 kg (95% confidence interval -2.86 kg to -1.59 kg)) and a trend towards a reduction in the prevalence of gestational diabetes (six randomised clinical trials; n = 1,011; odds ratio 0.80 (95% confidence interval 0.58 to 1.10)). There were no clear differences reported for other outcomes such as Caesarean delivery, large for gestational age, birth weight or macrosomia. All available studies were assessed to be of low to medium quality. CONCLUSION: Antenatal lifestyle intervention is associated with restricted gestational weight gain and a trend towards a reduced prevalence of gestational diabetes in the overweight and obese population. These findings need to be interpreted with caution as the available studies were of poor to medium quality

Interpregnancy weight change and adverse pregnancy outcomes: a systematic review and meta-analysis.

OBJECTIVES: To evaluate the effect of interpregnancy body mass index (BMI) change on pregnancy outcomes, including large-for-gestational-age babies (LGA), small-for-gestational-age babies (SGA), macrosomia, gestational diabetes mellitus (GDM) and caesarean section (CS). DESIGN: Systematic review and meta-analysis of observational cohort studies. DATA SOURCES: Literature searches were performed across Cochrane, MEDLINE, EMBASE, CINAHL, Global Health and MIDIRS databases. STUDY SELECTION: Observational cohort studies with participants parity from 0 to 1. MAIN OUTCOME MEASURES: Adjusted ORs (aORs) with 95% CIs were used to evaluate the association between interpregnancy BMI change on five outcomes. RESULTS: 925 065 women with singleton births from parity 0 to 1 were included in the meta-analysis of 11 studies selected from 924 identified studies. A substantial increase in interpregnancy BMI (>3 BMI units) was associated with an increased risk of LGA (aOR 1.85, 95% CI 1.71 to 2.00, p<0.001), GDM (aOR 2.28, 95% CI 1.97 to 2.63, p<0.001), macrosomia (aOR 1.54, 95% CI 0.939 to 2.505) and CS (aOR 1.72, 95% CI 1.32 to 2.24, p<0.001) compared with the reference category, and a decreased risk of SGA (aOR 0.83, 95% CI 0.70 to 0.99, p=0.044). An interpregnancy BMI decrease was associated with a decreased risk of LGA births (aOR 0.70, 95% CI 0.55 to 0.90, p<0.001) and GDM (aOR 0.80, 95% CI 0.62 to 1.03), and an increased risk of SGA (aOR 1.31, 95% CI 1.06 to 1.63, p=0.014). Women with a normal BMI (<25kg/m2) at first pregnancy who have a substantial increase in BMI between pregnancies had a higher risk of LGA (aOR 2.10, 95% CI 1.93 to 2.29) and GDM (aOR 3.10, 95% CI 2.74 to 3.50) when compared with a reference than women with a BMI ≥25 kg/m2 at first pregnancy. CONCLUSIONS: Gaining weight between pregnancies increases risk of developing GDM, CS and LGA, and reduces risk of SGA in the subsequent pregnancy. Losing weight between pregnancies reduces risk of GDM and LGA and increases risk of SGA. Weight stability between first and second pregnancy is advised in order to reduce risk of adverse outcomes. TRIAL REGISTRATION NUMBER: CRD42016041299

Change in level of physical activity during pregnancy in obese women: findings from the UPBEAT pilot trial

Background: Maternal obesity is associated with an increased risk of pregnancy complications, including gestational diabetes. Physical activity (PA) might improve glucose metabolism and reduce the incidence of gestational diabetes. The purpose of this study was to explore patterns of PA and factors associated with change in PA in obese pregnant women. Methods: PA was assessed objectively by accelerometer at 16 – 18 weeks’ (T0), 27 – 28 weeks’ (T1) and 35 – 36 weeks’ gestation (T2) in 183 obese pregnant women recruited to a pilot randomised trial of a combined diet and PA intervention (the UPBEAT study). Results: Valid PA data were available for 140 (77%), 76 (42%) and 54 (30%) women at T0, T1 and T2 respectively. Moderate and vigorous physical activity as a proportion of accelerometer wear time declined with gestation from a median of 4.8% at T0 to 3% at T2 (p < 0.05). Total activity as a proportion of accelerometer wear time did not change. Being more active in early pregnancy was associated with a higher level of PA later in pregnancy. The intervention had no effect on PA. Conclusions: PA in early pregnancy was the factor most strongly associated with PA at later gestations. Women should be encouraged to participate in PA before becoming pregnant and to maintain their activity levels during pregnancy. There is a need for effective interventions, tailored to the needs of individuals and delivered early in pregnancy to support obese women to be sufficiently active during pregnancy. Trial registration: Current Controlled Trials ISRCTN89971375 (Registered 28/11/2008)

The duration of sexual relationship and its effects on adverse pregnancy outcomes

This study aims to determine if a short duration of sexual relationship is more common among women who experience adverse pregnancy outcomes including gestational hypertension (GHT), preeclampsia, small for gestational age (SGA) pregnancies and spontaneous preterm birth (sPTB) with or without abnormal uterine artery Doppler compared to women who have uncomplicated pregnancies. 5591 nulliparous women from the Screening for Pregnancy Endpoints (SCOPE) study were included. The risk for pregnancy complications for women who had a duration of sexual relationship of ≤3 months, 4–6 months, 7–9 months, 10–12 months was compared with women who had a duration of sexual relationship of >12 months. Uterine artery Doppler was performed at 20 ± 1 weeks’ gestation. A short duration of sexual relationship (≤3 months) was more common among women with SGA in the presence of abnormal uterine artery Doppler [9.8% vs 3.0%, aOR (95% CI) 3.4 (1.6–7.08] compared to women who had uncomplicated pregnancies. A short duration of sexual relationship (≤3 months) was also more common among women who had abnormal uterine artery Doppler compared to those with normal uterine artery Doppler [6.1% vs 3.1%, aOR (95% CI) = 2.1 (1.4–3.2)]. A short duration of sexual relationship was not associated with preeclampsia after adjusting for confounders. A short duration of sexual relationship is more common among women who deliver SGA infants with features of placental insufficiency as indicated by abnormal uterine artery Doppler.Prabha Andraweera, Claire T. Roberts, Shalem Leemaqz, Lesley McCowan, Jenny Myers, Louise C. Kenny, James Walker, Lucilla Poston, Gus Dekker on behalf of the SCOP

Maternal and Paternal Body Mass Index and Offspring Obesity: A Systematic Review

Background/Aims: It has been hypothesized that the intrauterineenvironment is an independent factor in obesity development. If so, thematernal effect is likely to be a stronger influencing factor (’fetalovernutrition hypothesis’). We aimed to systematically evaluate theassociations of offspring body mass index (BMI, or adiposity) withpre-pregnancy BMI (or adiposity) of the mother and the father. Methods:The Medline, Embase and Cochrane Library databases were searched inMarch 2012. Results: Seven cohort studies were eligible for theanalysis. Among these, 2 groups of trials presented different data fromthe same parent-offspring cohorts (the Avon Longitudinal Study ofParents and Children, ALSPAC, and the Mater-University Study ofPregnancy, MUSP). In total, 3 large birth cohorts and 1 additional smallstudy were identified. Three studies provided a direct comparison ofparent-offspring associations, with a statistically stronger maternalinfluence found only in the MUSP cohort. Equivocal results were obtainedfrom all studies describing the ALSPAC cohort. The parental effect(indirectly estimated based on the presented odds ratio) was similar inthe Finnish cohort. In 1 additional small study, maternal BMI was foundto be a strong predictor of childhood obesity. Conclusions: There isonly limited evidence to support the ‘fetal overnutrition hypothesis’

A Prospective Cohort Study Investigating Associations between Hyperemesis Gravidarum and Cognitive, Behavioural and Emotional Well-Being in Pregnancy

Objectives: To investigate the association between hyperemesis gravidarum and altered cognitive, behavioural and emotional well-being in pregnancy. Methods: The study cohort consisted of 3423 nulliparous women recruited in the Screening for Pregnancy Endpoints (SCOPE) study performed in Auckland, New Zealand; Adelaide, Australia; Cork, Ireland; Manchester and London, United Kingdom between November 2004 and August 2008. Women were interviewed at 15±1 weeks' gestation and at 20±1weeks' gestation. Women with a diagnosis of hyperemesis gravidarum (HG) were compared with women who did not have a diagnosis of HG. Main outcome measures included the Short form State- Trait Anxiety Inventory (STAI) score (range 6–24), Perceived Stress Scale score (PSS, range 0–30), Edinburgh Postnatal Depression Scale (EPDS) score (range 0–30 or categories a–c) and behavioural responses to pregnancy score (limiting/resting [range 0–20] and all-or-nothing [range 0–28]). Results: During the study period 164 women suffered from HG prior to their 15 week interview. Women with HG had significantly higher mean STAI, PSS, EPDS and limiting response to pregnancy scores compared to women without HG. These differences were observed at both 15±1 and 20±1 weeks' of gestation. The magnitude of these differences was greater in women with severe HG compared to all women with HG. Women with severe HG had an increased risk of having a spontaneous preterm birth compared with women without HG (adjusted OR 2.6 [95% C.I. 1.2, 5.7]). Conclusion: This is the first large prospective study on women with HG. Women with HG, particularly severe HG, are at increased risk of cognitive, behavioural and emotional dysfunction in pregnancy. Women with severe HG had a higher rate of spontaneous preterm birth compared to women without HG. Further research is required to determine whether the provision of emotional support for women with HG is beneficial.Fergus P. McCarthy, Ali S. Khashan, Robyn A. North, Rona Moss-Morris, Philip N. Baker, Gus Dekker, Lucilla Poston, Louise C. Kenny on behalf of the SCOPE consortiu