Hostname: page-component-7bb8b95d7b-5mhkq Total loading time: 0 Render date: 2024-10-04T05:30:19.088Z Has data issue: false hasContentIssue false

Maternal obesity and excessive maternal weight gain during pregnancy: effects on outcomes after neonatal cardiac surgical procedures

Published online by Cambridge University Press:  14 December 2017

Rocky Tsang
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Pamela Hilvers
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Philip J. Lupo
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Ronald Bronicki
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Dean McKenzie
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
Paul A. Checchia*
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
*
Correspondence to: Professor P. A. Checchia, MD, FCCM, FACC, Department of Pediatrics, Critical Care and Cardiology, Cardiovascular Intensive Care Unit, Section of Critical Care Medicine, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin Street, Suite W6006, Houston, TX 77030, United States of America. Tel: +(832) 826 6214; Fax: +(832) 825 6229; E-mail: checchia@bcm.edu

Abstract

Introduction

Maternal obesity is associated with an increased risk for adverse perinatal outcomes. Obesity is also associated with a chronic inflammatory state and metabolic derangements that affect the newborn. The additional use of cardiopulmonary bypass during the neonatal period could impact the systemic inflammatory response in the immediate postoperative period that manifests as cardiac depression and multi-organ dysfunction. This study aimed to determine the association of maternal obesity and excessive weight gain during pregnancy with the immediate postoperative morbidity of neonatal patients undergoing cardiopulmonary bypass.

Methods

A retrospective review of neonates who underwent cardiopulmonary bypass within the first 30 days of life at our institution between 2011 and 2013 was conducted. Postoperative variables investigated included the duration of length of mechanical ventilation, length of stay in the ICU, peak vasoactive inotrope scores, and peak lactate level. Maternal obesity was defined as 1st trimester body mass index ⩾30 kg/m2. Excessive weight gain was defined as ⩾12 kg gained during pregnancy. In order to determine the association between maternal obesity or excessive weight gain and postoperative variables, we used multiple linear regression, adjusting for birth weight and risk adjustment for congenital heart surgery score.

Results

Records from 58 mother–baby dyads were examined. After controlling for birth weight and risk adjustment for congenital heart surgery score, there were no significant associations between maternal obesity and excessive weight gain during pregnancy versus all postoperative outcomes measured.

Conclusion

Despite the known negative impact of maternal obesity on perinatal outcomes, we were unable to find associations between maternal obesity and excessive weight gain during pregnancy versus postoperative outcomes.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Lu, GC, Rouse, DJ, DuBard, M, Cliver, S, Kimberlin, D, Hauth, JC. The effect of the increasing prevalence of maternal obesity on perinatal morbidity. Am J Obstet Gynecol 2001; 185: 845849.CrossRefGoogle ScholarPubMed
2. Hotamisligil, GS. Inflammation and metabolic disorders. Nature 2006; 444: 860867.CrossRefGoogle ScholarPubMed
3. Wellen, KE, Hotamisligil, GS. Inflammation, stress, and diabetes. J Clin Invest 2005; 115: 11111119.CrossRefGoogle Scholar
4. Schmatz, M, Madan, J, Marino, T, Davis, J. Maternal obesity: the interplay between inflammation, mother and fetus. J Perinatol 2010; 30: 441446.CrossRefGoogle ScholarPubMed
5. Bodnar, LM, Ness, RB, Harger, GF, Roberts, JM. Inflammation and triglycerides partially mediate the effect of prepregnancy body mass index on the risk of preeclampsia. Am J Epidemiol 2005; 162: 11981206.CrossRefGoogle ScholarPubMed
6. Simmons, R. Perinatal programming of obesity. Semin Perinatol 2008; 32: 371374.CrossRefGoogle ScholarPubMed
7. Gaies, MG, Gumey, JG, Yen, AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234238.CrossRefGoogle ScholarPubMed
8. Davies, GA, Maxwell, C, McLeod, L, et al. Obesity in pregnancy. J Obstet Gynaecol Can 2010; 32: 165173.CrossRefGoogle ScholarPubMed
9. American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: obesity in pregnancy. Obstet Gynecol 2013; 121: 213217.CrossRefGoogle Scholar
10. Mills, JL, Troendle, J, Conley, MR, Carter, T, Druschel, CM. Maternal obesity and congenital heart defects: a population-based study. Am J Clin Nutr 2010; 91: 15431549.CrossRefGoogle ScholarPubMed
11. Cedergren, MI, Källén, BAJ. Maternal obesity and infant heart defects. Obes Res 2003; 11: 10651071.CrossRefGoogle ScholarPubMed
12. Meehan, S, Beck, CR, Mair-Jenkins, J, Leonardi-Bee, J, Puleston, R. Maternal obesity and infant mortality: a meta-analysis. Pediatrics 2014; 133: 863871.CrossRefGoogle ScholarPubMed
13. Chu, SY, Kim, SY, Lau, J, et al. Maternal obesity and risk of stillbirth: a metaanalysis. Am J Obstet. Gynecol 2007; 197: 223228.CrossRefGoogle ScholarPubMed
14. Meenakshi, SR, Sharma, NR, Kushwaha, KP, Aditya, V. Obstetric behavior and pregnancy outcome in overweight and obese women: maternal and fetal complications and risks in relation to maternal overweight and obesity. J Obstet Gynaecol India 2012; 62: 276280.CrossRefGoogle ScholarPubMed
15. Mazumder, U, Sarker, S, Riaz, BK, Chowdhury, TA. Maternal over weight and obesity: its effect on pregnancy outcome. Mymensingh Med J 2011; 20: 213218.Google ScholarPubMed
16. Cedergren, MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004; 103: 219224.CrossRefGoogle ScholarPubMed
17. Paparella, D, Yau, TM, Young, E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg 2002; 21: 232244.CrossRefGoogle ScholarPubMed
18. Sasser, WC, Dabal, RJ, Askenazi, DJ, et al. Prophylactic peritoneal dialysis following cardiopulmonary bypass in children is associated with decreased inflammation and improved clinical outcomes. Congenit Heart Dis 2014; 9: 106115.CrossRefGoogle ScholarPubMed
19. Kalantar-Zadeh, K, Block, G, Horwich, T, Fonarow, GC. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol 2004; 43: 14391444.CrossRefGoogle ScholarPubMed
20. Padwal, R, McAlister, FA, McMurray, JJ, et al. The obesity paradox in heart failure patients with preserved versus reduced ejection fraction: a meta-analysis of individual patient data. Int J Obes (Lond) 2014; 38: 11101114.CrossRefGoogle ScholarPubMed
21. Kalantar-Zadeh, K, Kopple, JD. Obesity paradox in patients on maintenance dialysis. Contrib Nephrol 2006; 151: 5769.CrossRefGoogle ScholarPubMed