maternal-fetal medicine


Mom’s Obesity Linked To Potential Problems In Fetal Brain Development

In a small but provocative study, researchers found suggestions of abnormal brain development in the fetuses of obese women.

Specifically, researchers from the Mother-Infant Research Institute at Tufts Medical Center examined gene fragments (which can provide insight into fetal organ development, including the brain) in the amniotic fluid of both lean and obese women. As early as the second trimester, they detected differences in the gene expression in the fetuses of obese mothers compared to fetuses of women who were a healthy weight, they report.

(lunar caustic/flickr)

(lunar caustic/flickr)

The study only involved a total of 16 pregnant women, eight lean and eight obese.

Still, maternal obesity is a growing public health problem with 1 in 5 pregnant women in the U.S now obese. A whole host of health problems and complications have been linked to maternal obesity, including “higher rates of cesarean section, higher rates of infant birth defects and a three-fold higher incidence of neonatal death. Babies born to obese mothers, even if born at a normal weight, have been shown to have multiple metabolic problems with lifelong consequences,” according to the Mother-Infant Research Institute.

In this study, presented at the Society for Maternal-Fetal Medicine’s annual meeting in San Francisco last week, researchers reported that the fetuses of obese women had decreased apoptosis, a developmental process of programmed cell death. Andrea Goldberg Edlow, the study’s lead researcher and a fellow in Maternal-Fetal Medicine at Tufts Medical Center explained it this way: “One could think of apoptosis as being similar to necessary “pruning” or trimming away of excess material in the developing fetal brain. It is well-documented in animal models that apoptosis plays a critical role in brain development in utero.”

I asked Dr. Edlow a bit more about the research. Continue reading

10 Scary Reasons To Fight Obesity Before Pregnancy

Please forgive the piling on. There’s already enough pressure to lose poundage if you’re obese. And pregnant women already have plenty of worries, inflamed by crazymaking compilations of all that could go wrong like “What To Expect When You’re Expecting.”

But talk to the researchers at MIRI, Tufts Medical Center’s Mother Infant Research Institute, and you come away bowled over by all the powerful reasons to aim for a normal weight before pregnancy.

It turns out that obesity in pregnant women heightens risks in ways that you might never suspect: It increases the chances of stillbirths, birth defects, infections, even pediatric asthma — and the list goes on.

You also learn from the MIRI researchers that even if you do enter pregnancy obese, you can still make a difference by watching your weight during those critical months.

Doctors have long focused on women’s weight gain during pregnancy. But recent research has clarified the importance of a woman’s weight upon entering pregnancy as well, said Dr. Sarbattama Sen, a Tufts Medical Center neonatologist and researcher. “As time has gone on,” she said, “it’s become more and more clear that so many of the forces that are affecting fetal health are being exerted very early in pregnancy, before women even know they’re pregnant.”

At the same time, the obesity epidemic has spread, as well. At Tufts Medical Center, as at many hospitals, one in every five pregnant patients these days is obese — not just overweight, but obese — and the obstetrics department has had to add new beds made for larger mothers.

Dr. Errol Norwitz

Dr. Errol Norwitz, the hospital’s chief of obstetrics and gynecology, offers these first five reasons to lose weight before pregnancy, based mainly on risks to the mother’s own health; then Dr. Sen will add five focused more on the baby.

1. The most dangerous complications of pregnancy, the life-threatening ones, are far more common in obese women.

The two medical complications that are highest risk to the mother are blood clots in the legs that go to the lungs, and a condition called pre-eclampsia. They account for nearly 40 percent of all maternal deaths during pregnancy, and both are much more common in obese women.

Pre-eclampsia, for example, occurs in 5-8% of women overall, but 15-24% of morbidly obese women (those with a Body Mass Index over 40.) And as with many of these risks, there does appear to be a “dose effect:” the more obese you are, the higher the risk. Deaths are still exceedingly rare, but the danger does rise.

2. The risk of stillbirth also triples in morbidly obese women. Continue reading