Special Issues

Special Issue Title: Obesity in pregnancy: risks and management

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· Deadline for manuscript submissions: 28 February 2021

Special Issue Editor

Guest Editor

Prof. Gideon Koren, MD

Adelson faculty of medicine, Ariel University, and Motherisk Israel Program, Shamir Hospital, Israel

Website | E-Mail

Interests: Clinical pharmacology During Development; Drugs in Pregnancy

Special Issue Information

Dear Colleagues,

Obesity in pregnancy is associated with serious adverse maternal and fetal effects, including infertility, gestational diabetes, preeclampsia, intrauterine fetal and neonatal death, neural tube defects and many other. Because the prevalence of obesity in pregnancy has been steadily increased over the last few decades, its health impacts are much more serious. According to the World Health Organization, It has been estimated that overweight and obesity affect over 50 million women globally in upper and middle income countries. In the United States, a third of the women are obese and the yearly number of obese pregnant women exceeds 1 million.

Obesity-related hyperinsulinemia and subsequent hyperandrogenemia increase the risk of anovulatory cycles and the chance of conception decreases. Obesity is associated with increased risk of caesarian section, premature placental abruption, perineal tear, puerperal fever, severe puerperal infections, would healing complications, complications of obstetric anesthesia, postpartum hemorrhage, sepsis, obstetric shock, ICU admission and combined severe maternal morbidity and mortality. Maternal obesity is associated with long term overweight retention and its attendant long term morbidity with diabetes mellitus and cardiovascular risks. Maternal overweight and obesity are associated with increased risks for congenital malformations such as neural tube defects, cardiovascular risks, hydrocephaly, oral cleft and limb reduction anomalies.

In this special issue, leading scientists will be addressing emerging knowledge related to important challenges in evaluating, preventing and managing obesity in pregnancy, with focus on short and long term maternal risks, child risks, congenital malformations and pharmacological and non- pharmacological management.

Prof. Gideon Koren

Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at https://ceog.imrpress.org by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a double-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Clinical and Experimental Obstetrics & Gynecology is an international peer-reviewed open access quarterly journal published by IMR Press.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is $1250. Submitted papers should be well formatted and use good English.

Keywords

Obesity; Overweight; Pregnancy; Maternal risks; Fetal risks; Long term risks

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Planned Papers

Title: Maternal high fat diet and fetal programming of obesity
Author: Seray Kabaran

Title: Analysis of selected diet components
Author: Grazyna Jarz?k-Bielecka

Title: Patient with Martin-Bell syndrome and premenstrual syndrome, tendency to obesity from puberty
Author: Grazyna Jarz?k-Bielecka

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Gestational weight gain and long-term postpartum weight retention

Alexandra Berezowsky, Howard Berger

Clinical and Experimental Obstetrics & Gynecology 2021, 48 (3): 466-471. DOI: 10.31083/j.ceog.2021.03.2413

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Background: Excessive gestational weight gain is related to postpartum weight retention and multiple short- and long-term adverse outcomes. These include pregnancy related complications as preeclampsia and higher rates of cesarean delivery and long-term morbidities as future obesity and metabolic syndrome. Even so, more than half of the pregnant women gain excessive weight during their pregnancy. Methods: This review included a database search of Medline, ClinicalKey, PubMed, PubMed Central, Scopus, Ovid, and the Cochrane Database of Systemic Reviews. We included original articles, systematic reviews and meta-analysis published in peer-reviewed journals between January 1990 and October 2020 that addressed the correlation between excessive gestational weight gain, postpartum weight retention and maternal health issues. Only articles published in the English language that were available at full length, were included in this review. Results and discussion: After reviewing the literature, we discuss the risk factors for excessive gestational weight gain, the association between excessive gestational weight gain and postpartum weight retention and the implications of excessive gestational weight gain on women's future health. Finally, we highlight future research opportunities related to these issues.

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Birth defects associated with obesity

Ovadya Rosenbluh, Asnat Walfisch

Clinical and Experimental Obstetrics & Gynecology 2021, 48 (3): 472-477. DOI: 10.31083/j.ceog.2021.03.2377

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Background: In women of reproductive age, obesity is the most common medical condition. A condition which is increasing in prevalence worldwide. Obesity during pregnancy could have both short- and long-term adverse consequences for both mother and child. Methods: In this narrative review we discuss the most prominent observational studies and meta-analyses focusing on the association between maternal obesity (and BMI) and fetal congenital anomalies. Possible pathophysiological pathways linking the two are also discussed. Results: Obese women were found to have an increased at-birth prevalence of a wide range of fetal anomalies. These include congenital heart anomalies and neural tube defects, with a possible "dose-response" correlation. The reasons for that may include increased insulin resistance in early pregnancy and nutritional deficiencies, but also probably result from the challenges of fetal anomaly detection during a detailed ultrasound in obese women. Discussion: A large array of different fetal anomalies have been found to be increased in the maternal obese population. The incidence of fetal neural tube defects and serious heart anomalies among the obese population might grow by 30%. Congenital anomalies are known to be a major cause of stillbirth and infant mortality, and are important contributors to preterm delivery and childhood morbidity. The possible dose response pattern observed between the severity of obesity and teratogenic potential necessitates further investigation, which may also shed light on the underlying pathophysiology. The increasing prevalence of obesity in general and particularly in the pregnant population may thus have serious health implications. Education regarding the many risks associated with obesity, for mothers and their babies, are warranted.

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Pregnancy outcomes after inadvertent exposure of anti-obesity drugs during pregnancy

Eun Jeong Choi, Jung Yeol Han

Clinical and Experimental Obstetrics & Gynecology 2021, 48 (3): 514-522. DOI: 10.31083/j.ceog.2021.03.2331

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Backgrounds: To improve health, an increasing number of adults are attempting to lose weight. Moreover, the number of childbearing women targeting weight loss has increased, with a surge in pregnant women exposed to anti-obesity drugs. This study aimed to evaluate the ingredients, types, and trends of anti-obesity drugs and pregnancy outcomes among the exposures of anti-obesity drugs. Additionally, we reviewed their teratogenicity in literature. Methods: We performed a prospective cohort study and recruited pregnant women exposed to anti-obesity drugs in the Motherisk Database, from 2012 to 2018. We determined the frequency and type of anti-obesity drugs used. Furthermore, we compared the annual change in the frequency of anti-obesity drugs with that of total pregnancies. Overall, 30,704 pregnant women were enrolled during the study period. Results: The rate of pregnant women exposed to anti-obesity drugs was 4.8% (1487/30,704). The rate of pregnant women exposed to anti-obesity drugs significantly increased from 3.7% in 2012 to 7.4% in 2018 (p < 0.001). The most frequently used drugs were phentermine (33.0%) and phendimetrazine (25.9%). The number of pregnant women exposed to anti-obesity drugs has recently increased. There is no difference in pregnancy outcomes between the exposure and the un-exposure of anti-obesity drug except that birth weight and large for gestational age are significantly larger in the exposure group. Additionally, there are no difference of abnormalities between the exposure (3.1%) and the un-exposure of anti-obesity drugs (3.7%). Discussion: This study showed that the exposure of anti-obesity drug profoundly increased during the study period and there exist known teratogenic drugs. Therefore, childbearing women should be concerned with preventing teratogenic effects following anti-obesity drug exposure during pregnancy. Physicians should warn childbearing women about potential dangers of anti-obesity drug.

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Obesity, neural tube defects and folic acid—A complex relationship

Gideon Koren, Yusuf C Kaplan

Clinical and Experimental Obstetrics & Gynecology 2021, 48 (2): 223-227. DOI: 10.31083/j.ceog.2021.02.2304

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Obesity is associated with twofold increased risk of neural tube defects (NTD). Research has repeatedly shown that about 70% of NTD are folic-acid dependent. Yet, there is controversy whether folic acid status is the main determinant of the increased risk of obesity-induced NTD. The rational for this review is to update and discuss the evidence on the link between obesity, folic acid and NTD, in an attempt to shed light on the question whether optimal folic acid dose schedule can mitigate this risk. During pregnancy maternal folate requirements increase by 5–10-fold, as folate is diverted towards the placenta and fetus, as well as supporting different maternal organs. Correspondingly, low maternal folate status has been associated with birth defects in fetal anatomical regions particularly sensitive to reduced folate intake including oral cleft, cardiovascular defects and NTD. A recent study has documented decreased placental folate transporter expression and activity in the first and second trimesters among obese mothers. This may explain the higher incidence on NTD in infants of obese women, as less folate may find its way to the developing fetus during the sensitive periods for creating NTD. Recent pharmacokinetic results indicate that steady state levels of folate are almost perfectly defined by the dose per lean body weight (LBW). The mean dose per kg LBW that would be expected to result in steady state serum folate level of > 15.9 nmol/L was identified as 0.0073 mg/kg LBW. A large study found no differences in dietary supplementations of folic acid, yet obese women exhibited lower median serum folate as well as lower mean serum B12 levels, but no differences in mean RBC folate levels. There was a negative correlation between increasing BMI and both serum folate and plasma B12. Future research will be needed to incorporate more fully, in addition to evidence of NTD, obesity and folic acid intake, also direct measurements of serum and RBC folate, as well as other confounders, in order to create a model that will shed light on these complex interactions.

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Addressing optimal maternal weight and exercise during the preconception period and pregnancy

C.P. Moutos, V. Lozovyy, S.M. Clark

Clinical and Experimental Obstetrics & Gynecology 2020, 47 (5): 622-628. DOI: 10.31083/j.ceog.2020.05.9041

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Pregnancy is an opportunity for women to access the healthcare system and address their health needs. Before and during pregnancy, providers should emphasize assisting women in interventions aimed at establishing a healthy weight and exercise regimen and should tailor their guidance based on a woman's baseline level of fitness. Doing so will improve a woman's likelihood of pregnancy and improve outcomes if she does become pregnant. Our goal is to propose actions providers should take to improve a woman's understanding of and ability to manage her weight and exercise goals during the preconception and pregnancy periods.

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