Women with high BMI: Should they be managed differently due to antagonising action of leptin in labour?

Wuntakal, Rekha; Kaler, Mandeep; Hollingworth, Tony

doi:10.1016/j.mehy.2013.03.006

Cited by 24 publications

(16 citation statements)

References 14 publications

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“…Moreover, the increase of in labor CS for arrest of labor in women with obesity observed in our study is consistent with the literature that shows an altered rst phase of labor in women with obesity and an increase in labor obstruction [19,20] that might be due to a less effective myometrium in term of contractility [21] or a decrease in oxytocin receptors parallel to maternal BMI increase [22] and a higher blood rate of Leptin and cholesterol impairing myometrial contractility [23].…”

Section: Discussionsupporting

confidence: 92%

Use of the Robson classification to understand the increased risk of cesarean section in case of maternal obesity.

Créquit

Korb

Morin

et al. 2020

Preprint

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Background: The aim of this study was to identify characteristics of pregnant women with obesity that contribute to increased cesarean rate.Methods: Retrospective cohort in a single academic institution between 2012 and 2019. Women who delivered during this period were classified according to the Robson classification. Women with normal body mass index (N=11797) and with obesity (N=2991) were compared. The contribution of each Robson group to the overall caesarean rate were compared.Results: The overall cesarean rate was higher for women with (28.1%) than without (14.2%, p < 0.001) obesity. This result came mainly from Robson group 5a (history of one cesarean). After adjustment for medical factors within this group, the association between maternal obesity and cesarean during labor was significant.Conclusions: The higher cesarean rate in women with obesity is explained by Robson group 5a in which obesity is an independent risk factor of in labor cesarean delivery.

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Section: Discussionsupporting

confidence: 92%

Use of the Robson classification to understand the increased risk of cesarean section in case of maternal obesity.

Créquit

Korb

Morin

et al. 2020

Preprint

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“…Their role in altering the contractility of the myometrium has been mentioned. Leptin, a hormone produced by adipose tissue and thus having an increased presence in obese women, has been shown to reduce the influx of calcium ions into the uterine smooth muscle . It has also been shown that high levels of cholesterol, again found in the obese patient, inhibit calcium in the myometrium, leading to decreased contractility .…”

Section: Discussionmentioning

confidence: 99%

“…It has also been shown that high levels of cholesterol, again found in the obese patient, inhibit calcium in the myometrium, leading to decreased contractility . The inhibition of calcium by leptin and cholesterol therefore plays an antagonistic role to oxytocin, the action of which is to induce myometrial contractions by releasing intracellular calcium . The clinical manifestation of this antagonistic effect is an increase in the rate of cesarean sections, and also in the number of prolonged pregnancies, and the alteration in intensity and duration of labor in obese patients.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for failed induction of labor among pregnant women with Class III obesity

Kerbage

Senat

Drumez

et al. 2020

Acta Obstet Gynecol Scand

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| INTRODUC TI ONObesity and overweight are currently a public health problem in France. The World Health Organization has described obesity according to three increasing classes of severity as a function of body mass index (BMI), Class I (30-34.9 kg/m 2 ), Class II (35-39.9 kg/m 2 ) and Class III (≥40 kg/m 2 ). This description is correlated with the numbers and severity of complications observed in these populations. The specific and nonspecific complications of obesity are numerous. Cardiovascular complications are those responsible for the highest morbidity. 1 In obstetrics, obesity leads to the risk of complications (preeclampsia, gestational diabetes, pregnancy-induced Abstract Introduction: Our aim was to identify risk factors for failed induction in morbidly obese patients undergoing the induction of labor at term. Material and methods: This was a retrospective multicenter study on a cohort of 235 patients with a body mass index greater than 40 kg/m 2 and giving birth to a singleton in cephalic presentation, who had an induction of labor from 38 weeks of amenorrhea. Scheduled cesareans and spontaneous vaginal deliveries were excluded. Maternal, peri-partum and neonatal characteristics were analyzed according to the delivery route. Results: In all, 235 patients were included. Of these, 62.5% patients delivered vaginally and 37.5% by cesarean section. The frequency of nulliparity was greater in patients who had a cesarean section (56 [interquartile range, IQR, 38.1] vs 56 [IQR 63.6], P < .001). In multivariate analysis, nulliparity (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.58-4.97], P < .001), low Bishop's score (OR .794, 95% CI .70-.90, P < .001) and weight gain (OR 1.04, 95% CI 1.01-1.08, P = .033) were independent risk factors for failed induction. Umbilical cord pH at birth lower than 7 (0 vs 7 [IQR 8.0], P < .001) and lower than 7.20 (36 [IQR 24.5] vs 35 [IQR 39.8], P = .014) as well as the Apgar at 1 minute (14 [IQR 9.5] vs 17 [IQR 19.3], P = .032) was significantly higher in infants born by cesarean section. Conclusions: In this cohort, 63% of women with Class III obesity had successful inductions of labor; risk factors for failed induction include nulliparity and unfavorable Bishop score. K E Y W O R D S cesarean delivery, induction of labor, morbid obesity, obesity, pregnancy, vaginal delivery

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“…Leptin, which is a hormone produced by adipose tissue and therefore found in higher levels in obese women, has been shown to decrease the influx of calcium ions into uterine smooth muscle. 19 Elevated levels of cholesterol, which is again more common in obese women than normal weight women, have also been shown to inhibit calcium influx in the myometrium leading to decreased contractility. 20 The inhibition of calcium influx by both leptin and cholesterol in turn leads to an antagonist effect against oxytocin, which causes myometrial contractions by releasing calcium from intracellular stores.…”

Section: Pathophysiology Of Labor Induction In Obese Womenmentioning

confidence: 99%

Induction of labor in the obese patient

Ruhstaller

2015

Seminars in Perinatology

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Women with high BMI: Should they be managed differently due to antagonising action of leptin in labour?

Cited by 24 publications

References 14 publications

Use of the Robson classification to understand the increased risk of cesarean section in case of maternal obesity.

Use of the Robson classification to understand the increased risk of cesarean section in case of maternal obesity.

Risk factors for failed induction of labor among pregnant women with Class III obesity

Induction of labor in the obese patient

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