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- Ramö Isgren, Anna, et al.
(författare)
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Adverse Neonatal Outcomes in Overweight and Obese Adolescents Compared with Normal Weight Adolescents and Low Risk Adults
- 2019
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Ingår i: Journal of Pediatric and Adolescent Gynecology. - : ELSEVIER SCIENCE INC. - 1083-3188 .- 1873-4332. ; 32:2, s. 139-145
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Tidskriftsartikel (refereegranskat)abstract
- Study Objective: To evaluate the association between maternal body mass index and neonatal outcomes in adolescents and to compare neonatal outcomes between overweight and obese adolescents and obstetric low-risk adult women. Design: Retrospective cohort study using data from the Swedish Medical Birth Register. Setting: Sweden. Participants: All 31,386 primiparous adolescents younger than 20 years of age and 178,844 "standard" women, defined as normal weight, obstetric low-risk adult women who delivered between 1992 and 2013. The adolescents were categorized according to weight and height in early pregnancy into body mass index groups according to the World Health Organization classification. Logistic regression models were used. Interventions and Main Outcome Measures: Neonatal outcomes in relation to maternal body mass index groups. Results: In the adolescents, 6109/31,386 (19.5%) and 2287/31,386 (7.3%) were overweight and obese, respectively. Compared with normal weight adolescents, overweight adolescents had a lower risk of having small for gestational age neonates, and higher risks for having neonates with macrosomia, and being large for gestational age and with Apgar score less than 7 at 5 minutes. The obese adolescents had increased risk for having neonates being large for gestational age (3.8% vs 1.3%; adjusted odds ratio [aOR], 2.97 [95% confidence interval (CI), 2.30-3.84]), with macrosomia ( amp;gt;4500 g) (4.6% vs 1.4%; aOR, 2.95 [95% CI, 2.33-3.73]), and with Apgar score less than 7 at 5 minutes (2.2% vs 1.1%; aOR, 1.98 [95% CI, 1.43-2.76]) than normal weight adolescents. Compared with the standard women, overweight and obese adolescents had overall more adverse neonatal outcomes. Conclusion: Overweight and obese adolescents had predominantly increased risks for adverse neonatal outcomes compared with normal weight adolescents and standard women.
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| 2. |
- Ramö Isgren, Anna, et al.
(författare)
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Maternal body mass index and oxytocin in augmentation of labour in nulliparous women : a prospective observational study
- 2021
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:3
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Tidskriftsartikel (refereegranskat)abstract
- Objective To evaluate oxytocin use for augmentation of labour in relation to body mass index (BMI) on admission to the labour ward, focusing on cumulative oxytocin dose and maximum rate of oxytocin infusion during the first stage of labour. Design Prospective observational study. Setting Seven hospitals in Sweden. Participants 1097 nulliparous women with singleton cephalic presentation pregnancy, >= 37 weeks of gestation, spontaneous onset of labour and treatment with oxytocin infusion for labour augmentation. The study population was classified into three BMI subgroups on admission to the labour ward: normal weight (18.5-24.9), overweight (25.0-29.9) and obese (>= 30.0). The cumulative oxytocin dose was measured from the start of oxytocin infusion until the neonate was born. Primary outcome Cumulative oxytocin dose. Secondary outcome Maximum rate of oxytocin infusion during the active phase of first stage of labour. Results The mean cumulative oxytocin dose increased in the BMI groups (normal weight 2278 mU, overweight 3108 mU and obese 4082 mU (p<0.0001)). However, when adjusted for the confounders (cervical dilatation when oxytocin infusion was started, fetal birth weight, epidural analgesia), the significant difference was no longer seen. The maximum oxytocin infusion rate during the first stage of labour differed significantly in the BMI groups when adjusted for the confounding factors individually but not when adjusted for all three factors simultaneously. In addition, the maximum oxytocin infusion rate was significantly higher in women with emergency caesarean section compared with women with vaginal delivery. Conclusions Women with increasing BMI with augmentation of labour received a higher cumulative oxytocin dose and had a higher maximum oxytocin infusion rate during first stage of labour, however, when adjusted for relevant confounders, the difference was no longer seen. In the future, the guidelines for augmentation of labour with oxytocin infusion might be reconsidered and include modifications related to BMI.
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| 3. |
- Ramö Isgren, Anna, 1976-
(författare)
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Maternal overweight and obesity : impact on obstetric outcomes in adolescents and oxytocin in labor
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: The overall aim of this thesis was to evaluate the impact of maternal body mass index (BMI) on obstetric and neonatal outcomes in adolescents as well as on treatment with oxytocin infusion during labor regarding cumulative oxytocin dose and plasma levels of oxytocin.Material and Methods: Studies I and II were nationwide Swedish register studies including 31,386 primiparous adolescents subdivided in BMI groups and obesity classes according to early pregnancy BMI. Additionally, 178,844 low-risk normal weight adult women, called “the standard women” were included for comparison with the adolescents in the different BMI groups.Study III was an observational study conducted at seven maternity wards in the southeast region of Sweden, including 1,097 nulliparous women with spontaneous start of labor receiving oxytocin infusion during labor. The study group was subdivided according to BMI on admission to the labor ward. Cumulative oxytocin dose was registered from the start of the oxytocin infusion until the neonate was born. Study IV was an observational pilot study conducted at the maternity ward in Linköping, including 40 women in term labor receiving oxytocin infusion during the first stage of labor. The women were subdivided into obese and non-obese categories according to BMI on admission to the labor ward. Serial peripheral venous blood samples were taken during oxytocin infusion in the first stage of labor. The plasma oxytocin concentrations were analyzed with ultra performance liquid chromatography - Orbitrap tandem mass spectrometry at the Department of Chemistry Biomedical Centre, Uppsala University.Results: Compared with their normal weight counterparts and compared with the standard women, overweight and obese adolescents had increased risks for adverse pregnancy and neonatal outcomes such as preeclampsia, stillbirth, post-term pregnancy, neonates large for gestational age and neonates with low Apgar score. In labor, compared with the normal weight adolescents, the overweight and obese adolescents had a decreased chance for a normal vaginal delivery (VD), increased risk for Cesarean section (CS) and postpartum hemorrhage (PPH). However, compared with the standard women, the overweight adolescents had increased chance for a normal VD, and decreased risk for instrumental VD, CS, obstetric anal sphincter injury (OASI) and PPH in VD. The obese adolescents had an increased risk for CS but a decreased risk for instrumental VD and OASI and they had the same chance for a normal VD and no increased risk for PPH in VD.The mean cumulative oxytocin dose increased in the BMI groups (normal weight 2278 [2748] mU, overweight 3108 [3839] mU and obese 4082 [4895] mU (p<0.0001)) and the mean maximum oxytocin infusion rate during the first stage of labor was higher in the obese group compared with the overweight group of women (15.5 [9.5] mU/min vs. 13.6 [9.1] mU/min (p<0.05)). When adjusting for birth weight, epidural analgesia, and cervical dilation at the start of oxytocin infusion, the statistically significant differences were no longer seen. The obese women had increased median levels of oxytocin in plasma at an oxytocin infusion rate of 3.3 mU/min compared with the non-obese women (19.55 ng/mL [IQR 10.61; 29.06 ng/mL] vs. 6.97 ng/mL [IQR 5.55; 13.70 ng/mL], p=0.016).Conclusions: There are several adverse obstetric and neonatal outcomes associated with overweight and obesity in adolescents. It is important for clinicians to be aware of these outcomes in maternal health care. Nevertheless, overweight adolescents seemed to have better labor outcomes compared with low-risk adults, which is useful knowledge when risk-assessments are made in the labor ward.In spontaneous onset of labor, the cumulative oxytocin dose and maximum oxytocin infusion rate were higher in women with obesity compared with lower BMI groups. One explanatory factor seems to be that women with obesity received the oxytocin infusion at an earlier cervical dilatation stage. Furthermore, obese women seemed to have higher levels of oxytocin in plasma at the beginning of the oxytocin infusion. The oxytocin-oxytocin receptor complex must be further investigated to gain more knowledge on how to optimize the treatment of obese women with oxytocin infusion during labor.
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| 4. |
- Ramö Isgren, Anna, et al.
(författare)
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Obstetric Outcomes in Adolescents Related to Body Mass Index and Compared with Low-Risk Adult Women
- 2017
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Ingår i: Journal of Women's Health. - : MARY ANN LIEBERT, INC. - 1540-9996 .- 1931-843X. ; 26:5, s. 426-434
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate in adolescents the association between body mass index (BMI) and obstetric outcomes and to determine whether the outcomes in the BMI groups of adolescents differ from those of a low-risk population of adult women. Materials and Methods: This is a nationwide population-based register study. Obstetric outcomes of 31,386 singleton primiparous adolescents were evaluated in relation to BMI classes. Furthermore, the outcomes of the adolescents and 178,844 normal weight, nonsmoking, singleton primiparous women, 25-29 years old with no known comorbidity, defined as standard women, were compared. Multiple logistic regression models were used. Results are presented as crude odds ratios (ORs) or adjusted ORs and with a 95% confidence interval. Results: Compared with normal weight adolescents, obese adolescents had a lower chance of a normal vaginal delivery (VD)76% versus 85% [adjusted OR 0.61 (0.55-0.68)], a higher risk for acute cesarean section (CS)8.9% versus 4.5% [adjusted OR 2.45 (2.08-2.88)], and stillbirth0.7% versus 0.2% [adjusted OR 3.17 (1.74-5.77)]. Compared with standard women, overweight adolescents had a higher chance of a normal VD82% versus 75% [crude OR 1.53 (1.44-1.64)] and a lower risk for acute CS6.3% versus 7.1% [crude OR 0.85 (0.76-0.95)]. Obese adolescents had a lower risk for instrumental VD8% versus 13% [crude OR 0.61 (0.53-0.71)] and obstetric anal sphincter injury1% versus 3% [crude OR 0.38 (0.26-0.57)]. Conclusion: Several adverse obstetric outcomes were obesity related among adolescents. Overweight adolescents seemed to have better obstetric outcomes than standard women, something to consider when optimizing resources for women during pregnancy and delivery.
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| 5. |
- Ramö Isgren, Anna, et al.
(författare)
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The association between maternal body mass index and serial plasma oxytocin levels during labor
- 2023
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Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 18:8
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo evaluate the association between maternal body mass index (BMI) and plasma oxytocin (OT) levels at different OT infusion rates in labor.MethodsA prospective observational study analyzing serial plasma samples in laboring women with OT infusion. The women were categorized into three groups, women with non-obesity (BMI 18.5-29.9, n = 12), obesity (BMI 30.0-34.9, n = 13), and morbid obesity (BMI = 35.0, n = 15). Plasma OT was analyzed using tandem mass spectrometry.ResultsExcept for a low positive correlation between OT levels and BMI and significantly increased plasma OT levels in women with morbid obesity at the OT infusion rate of 3.3 mU/min, no significant differences in OT levels between the BMI groups were found. Further, the inter-individual differences in OT levels were large and no dose-dependent increase of OT levels was seen.ConclusionsOther factors than plasma OT levels may be more likely to determine the clinical response of OT infusion in women with obesity. Perhaps the observed clinical need and individual response would be a better predictor of plasma OT levels than a pre-determined OT infusion rate. The OT dosage guidelines for labor augmentation should be individualized according to clinical response rather than generalized.
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