الفهرس 
High Pre-pregnancy BMI and Maternal –Fetal RisksOnly 14 pages are availabe for public view
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Abstract
Obesity is becoming a real problem in socioeconomic and medical aspects. During the critical time of pregnancy, the inappropriate weight, either excessive or insufficient, could be related to important problems for maternal and neonatal outcomes.
The body mass index (BMI) is a controversial statistical measurement which compares a person’s weight and height. Though it does not actually measure the percentage of body fat, it is used to estimate a healthy body weight based on how tall a person is. Due to its ease of measurement and calculation, it is the most widely used diagnostic tool to identify weight problems within a population, usually whether individuals are underweight, overweight or obese.
Preterm labor is a common obstetric problem. The American College of Obstetricians and Gynecologists defined preterm birth as those infants delivered prior to the completion of 37 weeks’ gestation.
In several countries, the incidence of preterm labor has been reported to be 5-10% of all births, and this rate has been stable over the past two decades and varies between populations.
Preterm births account for about 75% of newborn deaths that are not related to birth defects. Preterm babies tend to grow slowly; they may have vision problems, impaired hearing, cardiovascular problems, breathing and CNS disorders, learning disabilities or behavior problems later in life.
Data regarding the relationship of preterm birth in obese women is contradictory. Overall, it seems that, in obese women, the increased risk of preterm birth is associated with obesity-related medical and antenatal complications and not some intrinsic predisposition to spontaneous preterm birth.
The obstetric complications of maternal obesity are generally related to issues of maternal pre-gravid obesity rather than excessive weight gain during gestation that results in a non-obese women becoming obese. There is good evidence that maternal early pregnancy weight, pattern of weight gain, and total pregnancy-related weight gain are important factors in determining birth weight. Birth weight has a major impact on neonatal morbidity and mortality, and also appears to affect long-term health and early adult weight. Total pregnancy weight gain was estimated by subtracting the early pregnancy weight (measured at the first antenatal visit) from the woman’s weight at the last antenatal visit.
The aim of this study was to detect the relationship between the early pregnancy high body mass index (BMI) and the risk of preterm labor. Also this study has demonstrated that many adverse outcomes of pregnancy are associated with maternal obesity and has provided quantification of these risks.
The study was conducted at Ain Shams university maternity hospital from June 2010 TO May 2011 and included 340 participants. All participants satisfying the criteria for inclusion divided into 2 groups according to their BMI:
Group 1: with normal BMI (18.5 and less than 24.99 kg/m2).
Group 2: with increased BMI (≥25 kg/m2).
Elevated BMI group (170 women) in our study were distributed as; over weight women (41.8%) and obese women (58.2%).
Inclusion criteria:
o Age 18-35 years.
o All included women of the same socioeconomic status.
o First antenatal visit < 20 weeks.
o Multipara.
o Singleton pregnancy.
Exclusion criteria:
o History of smoking.
o History of chronic diseases i.e. chronic hypertension, pre-gestational DM, heart diseases, bronchial asthma.
o Women at high risk for PTB (for example due to cervical incompetence, uterine malformation, multiple pregnancy or chronic maternal infections or to history of repeated previous PTB).
Women participating in this study were submitted for: informed consent, fully history taking, general examination, abdominal examination and local examination.
The participants were regularly followed up in the outpatient antenatal clinic till delivery and data on pregnancy outcome, weight gain and gestational age at delivery were obtained from the hospital filing system or by contacting the patients.
Regarding the results of this study; in comparison to the control group, the high BMI women were more exposed to complications of pregnancy such as gestational hypertension, gestational diabetes, macrosomia, IUGR, shoulder dystocia, cesarean section and wound infection.
Overweight and obese women have a significant increase in the risk of an induced preterm labor (before 37 weeks), while the risk of spontaneous preterm labor was increased in the normal weight group.
In both groups women whom gained more gestational weight were more suspected to complications of pregnancy, no relationship between gestational weight gain and preterm delivery was found in our study.