Metabolomic Pathways Predicting Labor Dystocia by Maternal Body Mass Index

Carlson, Nicole S.; Frediani, Jennifer K.; Corwin, Elizabeth J.; Dunlop, Anne L.; Jones, Dean P.

doi:10.1055/s-0040-1702928

Cited by 6 publications

(7 citation statements)

References 93 publications

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“…Unlike the composite measures of uterine responsiveness, there was no difference in either the mean or maximum MVU across the labor pattern groups, although there was a trend of both mean MVU and maximum MVU being lower among participants in the referent group (group 1 with no augmentation), compared with other groups (MVU 152. 15 3).…”

Section: Uterine Activitymentioning

confidence: 99%

“…1 Furthermore, ACOG and SMFM recommend accurate diagnosis of labor protraction and judicious use of cesareans for labor arrest as cornerstones of the latest efforts to safely reduce the cesarean birth rate. 1 A growing body of research indicates that incomplete physiologic changes before onset of labor [13][14][15] and uterine muscle fatigue 16,17 both contribute to labor dystocia in laboring people with varying degrees of obesity. For example, in recent research, metabolic, 18 inflammatory, 14 and endocrine function 13 changes were associated with both delayed onset of labor and slower labor progress.…”

Section: Introductionmentioning

confidence: 99%

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Characterizing uterine responsiveness to oxytocin augmentation across four labor patterns in maternal obesity

Kissler,

Carlson,

Hernandez

2023

Birth

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BackgroundOptimizing care during labor protraction is a key strategy for reducing cesareans, especially among people with obesity. The pathophysiology of labor dystocia remains poorly understood, limiting precise interventions targeting the cause of protraction.MethodsIn this secondary analysis of nulliparas (n = 92) with obesity (BMI ≥ 30 kg/m2) and spontaneous labor onset, we classified labor into four phenotypes based on duration of protraction and birth route: (1) no protraction, (2) short protraction and vaginal birth, (3) extended protraction meeting criteria for labor arrest, but with eventual progression and vaginal birth, and (4) extended protraction meeting criteria for labor arrest and cesarean birth. Across these phenotypes, we compared MVU, oxytocin dose, and novel measures of uterine responsiveness to oxytocin augmentation (MVU to oxytocin dose ratios).ResultsIn our sample, phenotype group 1 comprised 14.1% (n = 13); group 2 comprised 30.4% (n = 28); group 3 comprised 34.8% (n = 32); and group 4 comprised 20.7% (n = 19). Uterine responsiveness to oxytocin, but not MVU, decreased with each labor phenotype. Participants with cesarean birth had the lowest uterine responsiveness to oxytocin.ConclusionLabor and birth outcomes were associated with measures of uterine responsiveness to oxytocin rather than MVU alone, and thus these may be more clinically appropriate measures for guiding clinical decision‐making. Current criteria for labor arrest are likely too stringent for nulliparas with obesity, many of whom appear to progress to safe vaginal birth after longer labor durations. Differences in uterine responsiveness to oxytocin augmentation across the groups suggests underlying physiologic differences in the labor phenotypes, which should drive future research targeting pathophysiology.

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Section: Uterine Activitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Characterizing uterine responsiveness to oxytocin augmentation across four labor patterns in maternal obesity

Kissler,

Carlson,

Hernandez

2023

Birth

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“…Other metabolic pathways will also need to be explored. Indeed, recent metabolomics data has implicated fatty acid activation and glycophospholipid metabolism, both markers of dyslipidemia and lipotoxicity, in labor dystocia 35 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Association between Maternal Serum Lipids and Intrapartum Oxytocin Requirements during Labor Induction and Augmentation

et al. 2022

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Objective: To investigate the relationship between maternal serum lipid parameters and oxytocin requirements among women with term vaginal deliveries. Study Design: In this secondary analysis of a prospective cohort study, women who presented for delivery at ≥37 weeks gestation and received oxytocin during their labor were included. Maternal serum was collected intrapartum. The cohort was stratified into two groups based on maximum oxytocin infusion dose during labor. Primary outcomes were maternal total cholesterol, LDL-C, HDL-C and triglyceride levels. Generalized linear regression models were used to assess the association between lipid parameters and maximum oxytocin dose requirements while controlling for potential confounders. For secondary analyses, the cohort was stratified by HDL-C into two groups. Multivariable logistic regression was used to evaluate the relationship between low maternal HDL-C and additional intrapartum oxytocin parameters Results: There were no differences in maternal total cholesterol, LDL-C or triglyceride values between high and low maximum oxytocin groups. Median serum HDL-C was significantly lower among women in the high oxytocin group compared to those in the low oxytocin group (56mg/dL vs 62mg/dL, p<0.01). For every 0.26mg/dL lower HDL-C, women had one mU/min higher maximum oxytocin infusion dose during labor. Women with low serum HDL-C were also more likely to require maximum oxytocin doses above the 75th percentile (aOR 1.99, 95%CI 1.06-3.75) and above the 90th percentile (aOR 2.47, 95%CI 1.10-5.54). Among women undergoing induction of labor, low serum HDL-C was also associated with longer duration of oxytocin infusion (aOR 2.07, 95%CI 1.02-4.20). Conclusion: Low maternal HDL-C levels at term are associated with higher maximum oxytocin infusion doses among women undergoing labor induction or augmentation. Given the growing prevalence of metabolic syndrome in the United States and persistently high rates of cesarean delivery, HDL-C or its components may present a new target for predicting and improving labor outcomes.

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“…For example, in a study of 612 nulliparous women, the median cervical dilation time from 4 to 10 cm for those with BMI > 29 was significantly longer at 7.9 h versus just 6.2 h in those with a BMI ≤ 26 and 7.5 h for those with a BMI 26.1–29 13 and Bishop Scores for cervical ripening were lower upon admission for women with BMI of 30 or greater 12 . Sensitivity to prostaglandins, which promote cervical ripening, is also reduced in women with BMI > 30 14 The incidence of intra partum caesarean section for labor dystocia is also higher at higher BMI 15 – 17 , Although uterine contractility is reduced 18 , and even differences in the maternal serum metabolome 7 have been observed, the physiological mechanisms that underlie delays in the onset and progression of labor with increasing BMI remain poorly understood. At the same time, the incidence of preterm birth is also higher in women with BMI > 30.…”

Section: Introductionmentioning

confidence: 99%

Association of serum leptin at 24–28 weeks gestation with initiation and progression of labor in women

Branham

Sherman

Golzy

et al. 2022

Sci Rep

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Concentrations of the hormone leptin, which is produced by adipose tissue, increase with increasing BMI, whereas leptin sensitivity often declines with higher BMI. Thus, altered leptin signaling may play a role in reproductive health risks observed with increasing BMI, which include later onset and slow progression of labor. Conflicting evidence from clinical, animal and in vitro studies have suggested that leptin either promotes or inhibits labor. We hypothesized that serum leptin concentrations or serum leptin: body mass index (BMI) ratios in women may be associated with the initiation and progression of labor. Following informed consent, serum samples were collected from 90 women with singleton pregnancies at the time of routine glucose-challenge testing, for measurement of leptin. The potential influence of leptin on gestation length and cervical dilation timing were examined by multiple linear regression. Data were analyzed from 63 participants who met exclusion and inclusion criteria. Leptin concentrations (log-transformed) at 24–28 weeks gestation were not significantly correlated with first trimester BMI . Log serum leptin and leptin: BMI ratio each were significantly associated with shorter total gestation length in uncomplicated, term pregnancies. In contrast, the mid-pregnancy leptin concentrations were not associated with progression of labor, assessed by cervical dilation over time. The association between higher serum leptin and shorter gestation length is consistent with the hypothesis that leptin promotes, or is permissive for, the onset of labor.

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Metabolomic Pathways Predicting Labor Dystocia by Maternal Body Mass Index

Cited by 6 publications

References 93 publications

Characterizing uterine responsiveness to oxytocin augmentation across four labor patterns in maternal obesity

Characterizing uterine responsiveness to oxytocin augmentation across four labor patterns in maternal obesity

Association between Maternal Serum Lipids and Intrapartum Oxytocin Requirements during Labor Induction and Augmentation

Association of serum leptin at 24–28 weeks gestation with initiation and progression of labor in women

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