ObjectiveTo investigate the intrauterine fetal growth pattern and fetoplacental circulation in pregnancies following bariatric surgery.DesignProspective study.SettingMaternity Unit, UK.PopulationOne hundred and sixty‐two pregnant women; 54 with previous bariatric surgery and 108 with no surgery but similar booking body mass index.MethodsParticipants were seen at 11–14, 20–24, 30–33 and 35–37 weeks of gestation and an oral glucose tolerance test (OGTT) was performed at 27–30 weeks. Fetal head and abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW) and fetoplacental Dopplers were measured at three time‐points in pregnancy. Birthweight (BW) was recorded. Variables were modelled after adjustment for maternal/pregnancy characteristics. Model estimates are reported as posterior means and quantile‐based 90% credible intervals (CrI).Main outcome measuresFetal biometry, fetoplacental Doppler, BW.ResultsCompared with the no surgery group, the post‐bariatric surgery group had lower EFW during gestation (up to −120 g; [−189 g, −51 g] lighter) at 35–37 weeks, with smaller AC and FL. Similarly, infants of mothers with previous bariatric surgery had lower average BW [−202 g [−330 g, −72 g] lighter). Overall, there was no difference in the fetoplacental Doppler indices between groups but maternal glucose levels at OGTT were positively correlated with third‐trimester EFW and BW.ConclusionsFetuses of women with previous bariatric surgery are smaller during pregnancy and at birth, compared with those of women without such surgery, and this may be related to the lower maternal glucose levels seen in the former population. The fetoplacental circulation appears not to be altered by maternal weight loss surgery.Tweetable abstractOffspring of post‐bariatric women are smaller during pregnancy and at birth but this is not due to placental insufficiency.
Rectus femoris (RF) injuries are common in sports requiring maximal acceleration and sprinting. The British Athletics Muscle Injury Classification (BAMIC) describes acute muscle injury based on the anatomical site of injury and has been associated with return to play in hamstring and calf muscle injury. The aim of this study was to describe and compare the time to return to full training (TRFT) and injury recurrence for BAMIC‐classified RF injuries sustained by elite track and field (T&F) athletes over a 9‐year period. All rectus femoris injuries sustained by elite T&F athletes on the British Athletics World Class Program between September 2010 and September 2019 that were investigated with an MRI within 7 days of acute onset anterior thigh pain were included. Injuries were graded from the MRI by a specialist musculoskeletal radiologist using the BAMIC, and TRFT and injury recurrence were determined by evaluation of the Electronic Medical Record. Athlete demographics and World Athletics event discipline were recorded. Specific injury details including mechanism, location of injury, and whether surgical or rehabilitation management was undertaken were recorded. There were 38 RF injuries in 27 athletes (24.7 ± 2.3 years; 10 male, 17 female). Average TRFT for rehabilitation managed cases was 20.4 ± 14.8 days. Grade 1 injuries had significantly shorter TRFT compared with grades 2 (p = 0.04) and 3 (p = 0.01). Intratendinous (c) and surgically managed RF injuries each had significantly longer TRFT compared with other injury classes (p < 0.001). Myofascial (a) injuries had reduced repeat injury rates compared with b or c classes (p = 0.048). Grade 3 injuries had an increased repeat injury rate compared with other grades (p = 0.02). There were 4 complete (4c) proximal free tendon injuries sustained during sprinting and all in female athletes. The average TRFT for RF injuries in elite T&F is similar to that previously identified in elite football and Australian Rules. Similar to previous research in hamstring and calf injury, RF injuries extending into the tendon (BAMIC class c) had delayed TRFT which may reflect the longer duration required for tendon healing and adaptation. Grade 3 injuries had in increased repeat injury rate compared with grades 1 and 2. The BAMIC diagnostic framework may provide useful information for clinicians managing rectus femoris injuries in T&F.
Introduction To compare the gestational weight gain (GWG) between women with previous bariatric surgery and those without and investigate whether GWG correlates with birthweight (BW) or delivery of a small-for-gestational-age (SGA) neonate. Materials and Methods Prospective, longitudinal study, include 100 pregnant women with previous bariatric surgery and 100 without weight loss surgery, but with similar early-pregnancy body mass index (BMI). In a sub-study, 50 of the post-bariatric women were also matched to 50 women without surgery, but early-pregnancy BMI similar to the pre-surgery BMI of the post-bariatric ones. All women had their weight/BMI measured at 11–14 and 35–37 weeks of gestation, and the difference in maternal weight/BMI between the two time points was expressed as GWG/BMI gain. Associations between maternal GWG/BMI gain and birthweight (BW) were examined. Results Compared to no bariatric women with similar early-pregnancy BMI, post-bariatric women had similar GWG (p = 0.46), and the number of women with appropriate, insufficient, and excessive weight gain was comparable between groups (p = 0.76). However, post-bariatric women delivered smaller babies (p < 0.001), and GWG was not a significant predictor of BW or of delivering a SGA neonate. Compared to no bariatric women with similar pre-surgery BMI, post-bariatric ones had higher GWG (p < 0.01) but still delivered smaller neonates (p = 0.001). Conclusions Post-bariatric women seem to have similar or greater GWG compared to women without surgery matched for early-pregnancy or pre-surgery BMI, respectively. Maternal GWG was not associated with BW or higher prevalence of SGA neonates seen in women with previous bariatric surgery. Graphical Abstract
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On this limited data, either mechanical or chemical IOL in suspected IUGR/SGA is reasonable. However, a sizeable RCT specifically to answer the question of chemical versus mechanical IOL in this group, ± pooling of SGA subgroup data from general IOL trials, is required to provide definitive data. Objectives: To characterise lipid metabolomic changes in maternal and umbilical cord blood of pregnancies with sub-optimal fetal growth. Methods: Prospective cohort study in singleton term gestations including 27 normally grown newborns and 51 small fetuses classified into small for gestational age (SGA) (if birthweight 3rd-9th and had normal fetoplacental Doppler. n=27) and fetal growth restriction (FGR) (if birthweight <3rd centile and/or abnormal fetoplacental Doppler; n=24). Maternal and cord blood samples were analysed by 1 H-NMR and diffusion data assessed by targeted metabolomics to determine lipoprotein content, choline and glycoprotein compounds (Liposcale ® test). Results: Targeted lipidomics could clearly discriminate between the groups. Lipoprotein profiles showed significantly lower maternal concentrations of cholesterol-IDL (-17%), and triglycerides-IDL as well as -HDL in small fetuses (both, SGA and FGR) compared to controls (all p<0.05). While FGR fetuses had significant higher levels of cholesterol-VLDL (+56%). -IDL (+24%). triglycerides-VLDL (+24%) and -IDL (+18%) than controls (all p<0.005) (Figure). Changes in phosphatidylcholines and glycoproteins were more prominent in FGR vs. controls, indicating significant alterations in their abundance and biophysical properties. Conclusions: These results provide a substantial understanding of the widespread disruption of lipid profiles in both maternal and cord blood of pregnancies with suboptimal fetal growth.
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