Trends in Pre‐pregnancy Obesity in Nine States, 1993–2003

Kim, Shin Y.; Dietz, Patricia M.; England, Lucinda J.; Morrow, Brian; Callaghan, William M.

doi:10.1038/oby.2007.621

Cited by 367 publications

(257 citation statements)

References 31 publications

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“…Low-SES mothers live in more adverse environments, with greater exposure to such hazards as peeling lead-based paint, diesel exhaust, industrial emissions, and secondhand smoke (37,38), coupled with poorer access to health-promoting resources, such as recreational facilities, safe environments for exercise, full-service supermarkets, and produce markets (39). Such environments may foster overweight and obesity among low-SES women entering pregnancy and excessive or inadequate weight gain during pregnancy (40,41). These weight difficulties are associated with more adverse neonatal outcomes (42).…”

Section: Causality and Its Discontentsmentioning

confidence: 99%

Rigor, vigor, and the study of health disparities

Adler

Bush²,

Pantell

2012

Proc. Natl. Acad. Sci. U.S.A.

103

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Health disparities research spans multiple fields and methods and documents strong links between social disadvantage and poor health. Associations between socioeconomic status (SES) and health are often taken as evidence for the causal impact of SES on health, but alternative explanations, including the impact of health on SES, are plausible. Studies showing the influence of parents' SES on their children's health provide evidence for a causal pathway from SES to health, but have limitations. Health disparities researchers face tradeoffs between "rigor" and "vigor" in designing studies that demonstrate how social disadvantage becomes biologically embedded and results in poorer health. Rigorous designs aim to maximize precision in the measurement of SES and health outcomes through methods that provide the greatest control over temporal ordering and causal direction. To achieve precision, many studies use a single SES predictor and single disease. However, doing so oversimplifies the multifaceted, entwined nature of social disadvantage and may overestimate the impact of that one variable and underestimate the true impact of social disadvantage on health. In addition, SES effects on overall health and functioning are likely to be greater than effects on any one disease. Vigorous designs aim to capture this complexity and maximize ecological validity through more complete assessment of social disadvantage and health status, but may provide less-compelling evidence of causality. Newer approaches to both measurement and analysis may enable enhanced vigor as well as rigor. Incorporating both rigor and vigor into studies will provide a fuller understanding of the causes of health disparities.methodology | social determinants of health | cumulative risk G ood health and longevity are unequally distributed in populations. Although some unavoidable variations in health emanate from individual differences in vulnerability to disease, others are linked to membership in socially disadvantaged groups. The latter are unjust and have been the focus of considerable research and policy (1). Research on these health disparities has demonstrated consistent graded associations between various components of socioeconomic status (SES) and a wide range of health indicators; at each step up the social ladder, whether indexed by higher income, education, and/or occupational level, rates of morbidity and mortality decrease (2). The prevailing understanding of this relationship is that SES is a "fundamental cause" of health status (3), which operates through physical and/or psychosocial resources that are more readily available as SES increases, and hardships and adverse exposures that are more intense and frequent as SES decreases.Evidence for the SES-health gradient comes primarily from cross-sectional data linking contemporaneous measures of SES in adulthood with prevalence of disease, poor health, or mortality. Smaller literatures have established associations between socioeconomic conditions in childhood and childhood health, and betwe...

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Section: Causality and Its Discontentsmentioning

confidence: 99%

Rigor, vigor, and the study of health disparities

Adler

Bush²,

Pantell

2012

Proc. Natl. Acad. Sci. U.S.A.

103

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“…The prevalence of obesity among pregnant women ranges from 10 to 35%. [1][2][3][4][5] The combination of obesity and pregnancy creates additional risk factors for adverse maternal and infant health outcomes. The increased perinatal morbidity associated with maternal obesity such as preeclampsia, gestational diabetes, stillbirth, abnormal fetal growth and cesarean deliveries has caught the attention of obstetrician-gynecologists.…”

Section: Introductionmentioning

confidence: 99%

Maternal obesity: do patients understand the risks?

2010

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Objective: To evaluate patient knowledge of the risks of maternal obesity and compare knowledge between non-obese and obese women.Study Design: A face-to-face survey was administered to 105 women at their first prenatal visit. The survey assessed their knowledge of obesityrelated risks during pregnancy, weight history and goals and health behaviors. Descriptive statistics described the entire sample. Student's t-test and w 2 tests compared knowledge between non-obese (body mass index (BMI) of <30 kg m -2 ) and obese (BMI of X30 kg m -2 ) gravidas.Result: There were 56 (54%) non-obese and 47 (46%) obese participants. There were no significant differences between the weight groups with respect to age, race, insurance, education, tobacco use and primigravity. Overall, 49% participants knew that obesity increases risks in pregnancy. The knowledge of specific risks was similar in the non-obese (60% correct) and obese (64% correct) groups (P ¼ 0.76). Obese patients were more aware of the risk for diabetes (68 vs 96%, P<0.001). Obese gravidas expressed more interest in weight loss before another pregnancy (61 vs 81%, P ¼ 0.03), although the desired BMIs (22.1±2.3 vs 26.2 ± 3.0 kg m -2 , P<0.001) were different for non-obese and obese women, respectively. Of all participants, 9% discussed the risks of maternal obesity with a provider before study participation and 75% wanted to participate in a study on weight loss before pregnancy to determine whether it leads to healthier pregnancies.Conclusion: Regardless of BMI category, patients required more knowledge about the risks of obesity in pregnancy, requested additional information and were motivated to lose weight before future pregnancies. Because obese women underestimated their optimal weight loss goals, it is necessary to target this group for further education.

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“…the adverse consequences of obesity in pregnancy (1,2). In non gravid individuals, obesity is described as a low grade inflammatory condition associated with increased production of pro-inflammatory factors which originate from the macrophages infiltrating the adipose tissue (3,4).…”

mentioning

confidence: 99%

Obesity in Pregnancy Stimulates Macrophage Accumulation and Inflammation in the Placenta

et al. 2008

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Obesity and pregnancy are associated with a combination of insulin resistance and inflammatory changes which exacerbate in combination. Based on the similarity between the inflammatory transcriptomes of adipose tissue and placenta, we hypothesized that the placenta develops exaggerated inflammation in response to obesity. The aim of this study was to characterize placental inflammatory mediators and macrophage accumulation in relation to peripheral inflammation in obesity.Placental macrophages and maternal peripheral mononuclear cells from 20 obese and 15 lean women were functionally and phenotypically characterized using immunohistochemistry, flow cytometry and expression for macrophage markers and inflammatory cytokines. The number of resident CD68+ and CD14+ cells was increased 2-3 fold in placenta of obese as compared to lean women. The enhanced macrophage population was characterized by a marked phenotypic heterogeneity with complex subsets of CD14+, CD68+ and CD11b+ cells and by an increased expression of the pro-inflammatory mediators IL-1, TNF-alpha, IL-6. Placental inflammation was associated with an activation of peripheral blood mononuclear cells with high amount of CD14, TNF-alpha, IL-6 and the chemokine receptors CCR2 and IL8-R in maternal but not fetal circulation. Additionally, plasma CRP and IL-6 concentrations were higher in obese compared to lean women.In conclusion, the chronic inflammation state of pre-gravid obesity is extending to in utero life with accumulation of an heterogeneous macrophage population and proinflammatory mediators in the placenta. The resulting inflammatory milieu in which the fetus develops may have critical consequences for short and long term programming of obesity. KeywordsObesity; pregnancy; placenta; inflammation; cytokines; fetus; programming The association between excess neonatal adiposity and high pre-gravid BMI and the alarming rise in the number of overweight women of reproductive age, call for elucidating the adverse consequences of obesity in pregnancy (1,2). In non gravid individuals, obesity is described as a low grade inflammatory condition associated with increased production of pro-inflammatory factors which originate from the macrophages infiltrating the adipose tissue (3,4). During pregnancy, however, the placenta becomes a significant source of a variety of cytokines and adipocytokines whose expression is dysregulated by maternal diabetes and obesity (5-7).Pregnancy is considered as a natural inflammatory state evident in activation of maternal leucocytes and increased systemic concentration of acute phase reactants and cytokines (8).The physiological inflammatory state of pregnancy becomes exaggerated when pregnancy is complicated by pre-eclampsia and gestational diabetes and returns to baseline levels after delivery (9-11). Products of inflammatory stress secreted by the placenta and microparticules shedding from the syncytial surface of the placenta into the systemic circulation have been proposed as mechanisms driving adaptive immunity (1...

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Trends in Pre‐pregnancy Obesity in Nine States, 1993–2003

Cited by 367 publications

References 31 publications

Rigor, vigor, and the study of health disparities

Rigor, vigor, and the study of health disparities

Maternal obesity: do patients understand the risks?

Obesity in Pregnancy Stimulates Macrophage Accumulation and Inflammation in the Placenta

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