Obese pregnant women develop severe insulin resistance and enhanced systemic and placental inflammation, suggesting associated modifications of endocrine and immune functions. Activation of innate immunity by endotoxins/lipopolysaccharides (LPS) has been proposed as a mechanism for enhancing metabolic alterations in disorders with insulin resistance. The aim of this study was to characterize the immune responses developed by the adipose tissue AT and their potential links to maternal endotoxemia in pregnancy with obesity. Blood and subcutaneous abdominal AT were obtained from 120 lean and obese women (term pregnancy) recruited at delivery. Gene expression was assessed in AT and stromal vascular cells isolated from a subset of 24 subjects from the same cohort. Doubling of plasma endotoxin concentrations indicated subclinical endotoxemia in obese compared with lean women. This was associated with significant increase in systemic CRP and IL-6 but not TNF-alpha concentrations. AT inflammation was characterized by accumulation of CD68+ macrophages with a 3-fold increased gene expression of the macrophage markers CD68, EMR1 and CD14. Gene expression for cytokines IL-6, TNF-α, IL-8, and MCP1 and for LPS - sensing CD14, TLR4, TRAM2 was 2.5-5 fold higher in stromal cells of obese compared to lean. LPS-treated cultured stromal cells of obese women expressed a 5-16 fold stimulation of the same cytokines up-regulated in vivo. Our data demonstrate that subclinical endotoxemia is associated with systemic and AT inflammation in obese pregnant women. Recognition of bacterial pathogens may contribute to the combined dysfunction of innate immunity and the metabolic systems in AT.

OBJECTIVE To estimate whether neonates of African American women have lower birth weights because of either decreased lean body mass or fat mass. METHODS A secondary analysis of a cohort of 104 African American and 274 Caucasian term, singleton, healthy pregnancies were identified. Women with existing gestational or gestional diabetes were excluded. Neonatal body composition was estimated using anthropometric measurements. RESULTS There were significant differences in maternal age (29.5 versus 25.8, p <0.001), pre-pregnancy body mass index (26.2 compared with 30.9 kg/m2, p<0.001), and weight gain during pregnancy (15.2 compared with 13.4 kg, p=0.03) in Caucasian compared with African American women, respectively. After adjusting for these factors, African American women’s neonates had significantly lower birthweights (3.20 compared with 3.36 kg, p=.003), less lean body mass (2.80 compared with 2.94 kg, p=0.002), and no difference in fat mass (392 compared with 417g, p=0.071). CONCLUSION Decreased birthweight in African American neonates is due to lower lean body mass and not a difference in adiposity.

Preterm premature rupture of the membranes remains a common cause of preterm deliveries and neonatal morbidities. The goal of this study is to review the evidence with regard to the antibiotic treatment after preterm premature rupture of the membranes, long-term outcomes related to antibiotic treatment, and possible complications with treatment. Future research goals are also discussed.