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Celebrate the ups and downs of your pregnancy with this interactive journal, which invites you to record in detail this most extraordinary period of your life. A thick-walled gestational sac (GS)-like structure was demonstrated lateral to the uterus in all cases. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser. Maternal obesity during pregnancy is an important public health problem in Western countries.
IntroductionObesity, cardiovascular disease and type 2 diabetes are major public health problems. Recommended gestational weight gain guidelines according to womena€™s prepregnancy body mass index. As described previously, both maternal prepregnancy obesity and excessive gestational weight gain seem to have persistent effects on various childhood outcomes [38]. Fetal developmentMaternal prepregnancy obesity and excessive weight gain during pregnancy are important risk factors for a variety of adverse fetal outcomes (Table 2). It is well-known that maternal prepregnancy obesity and excessive gestational weight gain are associated with an increased risk of large-size-for gestational age at birth [42, 43].
Cardiovascular and metabolic development in childhoodMaternal prepregnancy obesity and excessive gestational weight gain are associated with an increased risk of obesity in childhood and adolescence (Table 2).
Cardiovascular and metabolic disease in adulthoodMultiple studies have shown that a higher maternal prepregnancy body mass index is associated with a higher adult body mass index in the offspring, independent from socio-demographic and lifestyle-related confounding factors [74a€“76] (Table 2). Approaches to assess causality for the observed associationsThe major limitation of these observational studies is confounding.
Programming effects of maternal obesity during pregnancyHypothesisThe mechanisms underlying the associations of maternal obesity or excessive gestational weight gain with cardiovascular and metabolic disease in the offspring are not known yet. Specific maternal exposuresMaternal prepregnancy obesity and excessive gestational weight gain are complex traits, which reflect multiple components. Perspectives for future epidemiological researchCurrent evidence from epidemiological studies suggests that maternal obesity and excessive weight gain during pregnancy have important adverse consequences on cardiovascular and metabolic development from fetal life onwards, leading to disease in later life. First, despite extensive adjustment for potential confounding factors in these observational studies, residual confounding may still be an issue.
ConclusionsMaternal prepregnancy obesity and excessive weight gain during pregnancy seem to be important risk factors for an adverse in utero environment and long-term adverse cardiovascular and metabolic outcomes in the offspring. We conducted a nested case–control study including 407 cases and 2,075 frequency matched controls to investigate the association between maternal infections during pregnancy and risk of autism spectrum disorders (ASD). With annotated prompts for you to fill in for each week of your pregnancy, storage wallets and sealable envelopes for keeping precious momentos, and photo spaces for you to capture the changing shape of your body, this journal will be a life-long keepsake of all your special memories. On T2-weighted images, the thick wall typically exhibited 3 discrete rings in 22 cases (81 %), among which 17 cases (63 %) displayed small vessels and 6 cases (33 %) exhibited small areas of fresh haemorrhage inside the thick wall. The characteristic MRI features include a GS-like structure with a “three rings” appearance on T2-weighted images, presence of solid components in the sac, dilatation of the affected fallopian tube with hematosalpinx, and tubal wall enhancement.
Currently, obesity prevalence rates in pregnant women are estimated to be as high as 30 %.
These common diseases have a large impact on morbidity and mortality in the general adult population [1a€“4].
This review update is focused on the associations of maternal obesity and excessive weight gain during pregnancy with specifically cardiovascular and metabolic development in the offspring from fetal life until adulthood.
A recent meta-analysis among 13 studies showed that, as compared to maternal prepregnancy normal weight, maternal prepregnancy obesity was associated with a twofold higher risk of delivering a large size for gestational age infant [42]. A meta-analysis among 4 studies showed that maternal prepregnancy obesity was associated with a threefold higher risk of childhood obesity [60]. Similarly, increased maternal weight gain during pregnancy has been associated with higher offspring adiposity levels in adulthood [74, 76a€“79]. Various family-based socio-demographic, nutritional, lifestyle related and genetic characteristics may explain the observed associations of maternal prepregnancy body mass index and gestational weight gain with adverse health outcomes in the offspring. The fetal overnutrition hypothesis suggests that increased placental transfer of nutrients to the developing fetus in obese mothers and mothers with high levels of gestational weight gain, may subsequently affect fetal development, fetal fat deposition and the development of the hypothalamic-endocrine system that controls appetite and energy metabolism [91a€“93]. Maternal prepregnancy obesity reflects maternal nutritional status, fat accumulation and low-grade inflammation, whereas maternal weight gain during pregnancy additionally reflects maternal and amniotic fluid expansion and growth of the fetus, placenta and uterus [37].Maternal prepregnancy obesity is an indicator of a poor quality maternal diet.
Well-designed epidemiological studies are needed to identify the extent of causality of the observed associations, the underlying exposures and their critical periods, the developmental adaptations, and the potential for development of preventive strategies to improve long-term health outcomes of offspring. Cases, controls, and maternal infections were ascertained from Kaiser Permanente Northern California clinical databases.
Grether was formerly with Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA, 94804, USA.The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
However, in advanced pregnancy, such cases can sometimes pose a diagnostic dilemma and are recognized only when patient presents with abdominal pain and collapse and is taken for laparotomy.
These pregnancies hardly reach viability and often result in rupture of the horn in second trimester. Rupture of pregnant noncommunicating rudimentary uterine horn with fetal salvage: A case report.
Placenta accreta associated with a ruptured pregnant rudimentary uterine horn: Case report and review of the literature.
MR imaging of maternal diseases of the abdomen and pelvis during pregnancy and the immediate postpartum period.
Each chapter offers guidance on what to expect, notes on your baby's development during each trimester, and reminders on what you need to be planning, thinking about and preparing for. The contents demonstrated non-specific liquid in 26 %, papillary solid components in 56 %, and fresh blood or fluid-fluid level in 19 % of the cases. In addition, approximately 40 % of women gain an excessive amount of weight during pregnancy in Western countries. Various socio-demographic and lifestyle-related risk factors for these diseases have been identified in both childhood and adulthood, of which many have been published in this journal [5a€“26]. Results from recent studies, methodological considerations, potential underlying mechanisms and challenges for future studies are discussed. When this meta-analysis was restricted to studies that performed adjusted analyses, results did not materially change. Studies using more detailed maternal weight and fetal growth measurements showed that a higher maternal prepregnancy body mass index was associated with a higher estimated fetal weight from second trimester onwards, with stronger associations at older gestational age [44].
Similarly, a meta-analysis among 12 studies showed that as compared to a recommended amount of gestational weight gain according to the IOM criteria, excessive gestational weight gain was associated with a 33 % increased risk of childhood obesity [61].
A study among 2432 Australians showed that higher maternal gestational weight gain was, independent from maternal prepregnancy body mass index, associated with a higher body mass index and tended to be associated with a higher systolic blood pressure in the offspring at the age 21 years [79]. Few studies used more sophisticated study designs to obtain further insight into the role of confounding in the observed associations, including sibling comparison studies, maternal and paternal offspring comparisons analyses, Mendelian randomization studies, and randomized controlled trial analyses, as described previously [38].First, sibling comparison studies enable better control for potential confounding factors shared within families [81].
These adaptations may predispose individuals to a greater risk of adverse health outcomes in later life. Both macronutrients and micronutrients intake related to a Western diet may influence fetal cardiovascular and metabolic development, through influences on placental transfer and subsequently offspring fat deposition, adipocyte function, pancreatic function and food preference [91, 94]. Large observational studies that are able to apply more sophisticated methods, such as parent-offspring comparison studies, sibling comparison studies and Mendelian randomization-studies are needed to obtain further insight into the causality of the associations of interest. Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology.
Autism Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders.
Prenatal immune challenge compromises the normal course of neurogenesis during development of the mouse cerebral cortex.
We report one such rare case of a nulliparous female who was carrying on well with her pregnancy till she developed symptoms of acute abdomen at 28 weeks of gestation. In our case though the patient presented with signs of hemoperitoneum at seven months of pregnancy, the cause was placenta percreta perforating the fundus of an intact horn and timely laparotomy saved both mother and fetus. Whether you are a first-time mother or want to commemorate a new addition to the family, Alison Mackonochie (author of the award-winning Emma's Diary) ensures that you will be comfortable every step of the way. Dilatation of the affected fallopian tube associated with hematosalpinx was demonstrated in 18 cases (67 %) and marked enhancement of the tubal wall was observed in 22 cases (81 %).
An accumulating body of evidence suggests a long-term impact of maternal obesity and excessive weight gain during pregnancy on adiposity, cardiovascular and metabolic related health outcomes in the offspring in fetal life, childhood and adulthood.
Also, adverse exposures during the fetal and early postnatal period may influence the risk of adverse health outcomes in later life [27].
In line with this meta-analysis, a study among 1857,822 live single births in Sweden showed that a higher maternal body mass index in early pregnancy was associated with an increased risk of infant mortality, especially among term births (a‰?37 weeks) [40].
Especially higher second and trimester maternal weight gain seem to be associated with an increased risk of large size for gestational age at birth [45, 46]. The associations of maternal obesity during pregnancy with more detailed childhood fat mass measures have also been studied.
A study among 1400 mother-offspring pairs in Jerusalem showed that higher maternal prepregnancy body mass index was associated with a higher body mass index, waist circumference, blood pressures, insulin and triglyceride levels and lower HDL cholesterol in the offspring aged 32 years [74].
A sibling comparison study among offspring from mothers who had high levels of prepregnancy weight loss due to gastrointestinal bypass surgery showed that the risk of overweight and obesity and adverse cardio-metabolic risk factors was higher in children born to mothers before surgery than those born to mothers after surgery [82, 83].
Figure 1 shows potential mechanisms that might be involved in the associations of higher maternal prepregnancy body mass index and gestational weight gain with the risks of cardiovascular and metabolic disease in the offspring. A study among 585 mothers and their children showed that a maternal diet during pregnancy high in saturated fat and sugar intake was associated with an increased risk of offspring obesity [95].
Long-term follow-up of participants in trials focused on reducing maternal weight throughout pregnancy will also provide further insight into the causality.
The role of cytokines in mediating effects of prenatal infection on the fetus: Implications for schizophrenia. Maternal immune activation and autism spectrum disorder: Interleukin-6 signaling as a key mechanistic pathway. She underwent USG and MRI but it was only after laparotomy that a final diagnosis of a pregnancy in a rudimentary horn with placenta percreta perforating through the fundus could be made.


No correlation was found between the size of the GS and the estimated gestational age (r?=?0.056). In this review, we discuss results from recent studies, potential underlying mechanisms and challenges for future epidemiological studies.
Previous epidemiological studies have shown that both low and high birth weight are associated with increased risks of obesity, cardiovascular disease and type 2 diabetes in later life [27a€“31]. This association was mainly explained by congenital anomalies, birth asphyxia, other neonatal morbidities, sudden infant death syndrome or infections [40]. Furthermore, multiple observational studies have reported that maternal prepregnancy obesity and excessive gestational weight gain are associated with increased risks of low Apgar score, neonatal hypoglycemia and referral to neonatal intensive care unit [47]. Several studies have shown that a higher maternal prepregnancy body mass index is associated with a higher childhood waist circumference and total body fat mass [62a€“65]. Adjustment for adult concurrent body mass index fully explained the associations of maternal prepregnancy body mass index with cardio-metabolic risk factors in adulthood. A sibling comparison study among 42,133 women who had more than one singleton pregnancy and their 91,045 offspring showed that higher maternal total gestational weight gain was associated with a higher body mass index in childhood [84]. Also, several studies suggested that a low maternal Omega-3 and high Omega-6 fatty acids intake and plasma levels are associated with an increased risk of obesity in the offspring [96a€“98]. Large meta-analyses are needed to obtain further insight into the strength, consistency and independency of the associations.Second, the underlying mechanisms of the observed associations of maternal obesity during pregnancy with offspring health outcomes remain unclear. Amniotic fluid chemokines and autism spectrum disorders: An exploratory study utilizing a Danish Historic Birth Cohort.
Amniotic fluid inflammatory cytokines: Potential markers of immunologic dysfunction in autism spectrum disorders.
Maternal infection requiring hospitalization during pregnancy and autism spectrum disorders. Is maternal influenza or fever during pregnancy associated with autism or developmental delays?
There was a significant amount of hemoperitoneum; however, the horn was intact and the fetus could be salvaged. There was no history of any discharge per vaginum, loss of fetal movements, abdominal trauma, or any bladder or bowel disturbance. Recently, a meta-analysis of multiple randomized controlled trials showed that dietary and physical activity interventions aimed at reducing maternal weight gain during pregnancy may lead to small reductions in the amount of gestational weight gain and to lower risks of adverse fetal outcomes [48].Fewer studies assessed the direct influence of maternal obesity during pregnancy on placental and fetal cardiovascular and metabolic development. In the same study, higher maternal gestational weight gain was only associated with increased adiposity levels in adult offspring [74]. A study among 906 mothera€“child pairs showed that higher maternal dietary glycemic index and glycemic load in early pregnancy, but not later in pregnancy, were associated with higher fat mass in childhood [99].
Animals studies have identified multiple pathways that may be involved in these associations, but these pathways remain largely unexplored in humans. Maternal autoimmune diseases, asthma and allergies, and childhood autism spectrum disorders: A case-control study.
Maternal Rh D status, anti-D immune globulin exposure during pregnancy, and risk of autism spectrum disorders. Increased mid-gestational IFN-gamma, IL-4, and IL-5 in women giving birth to a child with autism: A case-control study.
Causal knowledge as a prerequisite for confounding evaluation: An application to birth defects epidemiology.
The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism.
Maternal influenza infection causes marked behavioral and pharmacological changes in the offspring. She was gravida two with one spontaneous abortion at 3 months of gestation about one year back, for which a curettage was done. Thus, previous research suggests that both restricted and excessive nutritional in utero environments may lead to cardiovascular disease in later life.In Western countries, maternal obesity during pregnancy is an important adverse risk factor for an excessive nutritional in utero environment [33, 34]. It has been shown that maternal prepregnancy obesity is associated with higher placental weight, placental vascular dysfunction, placental inflammation and alterations in placental transporters activity and mitochondrial activity [49a€“55]. Higher maternal weight gain during pregnancy is, independent from maternal prepregnancy body mass index, associated with a higher childhood body mass index, but associations with other fat mass measures are less consistent [65a€“70]. Another study among 308 Danish mother-offspring pairs, which assessed the associations of maternal weight gain among normal weight women, showed that a higher maternal weight gain was associated with higher insulin levels and leptin levels among male offspring only [77]. A study among approximately 3000 mothers, fathers and their children showed that maternal dietary intake of proteins, fat and carbohydrates during pregnancy, but not paternal dietary intake, was associated with the childa€™s dietary intake of the same macronutrients.
Maternal prepregnancy obesity and excessive gestational weight gain are complex traits, which reflect multiple lifestyle-related and biological components, which complicates identification of potential underlying pathways. Autism after infection, febrile episodes, and antibiotic use during pregnancy: An exploratory study.
Atypical development of white matter microstructure in adolescents with autism spectrum disorders. Prevalence of self-reported infection during pregnancy among control mothers in the National Birth Defects Prevention Study. The UCLA-University of Utah epidemiologic survey of autism: Prenatal, perinatal, and postnatal factors. Currently, the obesity prevalence rate in pregnant women is estimated to be as high as 30 % [35, 36].
A study among 1035 mother-infant pairs showed that placental weight partially mediates the effect of maternal prepregnancy obesity and excessive gestational weight gain on birth weight [49]. Also, both maternal prepregnancy obesity and excessive gestational weight gain seem to be associated with a higher blood pressure, adverse lipid profile, insulin resistance and higher inflammatory markers in childhood [62, 66, 68, 71, 72]. Recently, a study using birth records from 37,709 participants, showed that a higher maternal body mass index at the first antenatal visit was associated with an increased risk of premature all-cause mortality and hospital admissions for cardiovascular events in adult offspring [80]. A limitation of sibling comparison studies is that next to the major exposure of interest, such as maternal body mass index, other related characteristics may also change over time.Second, several studies compared the strength of associations of maternal and paternal body mass index with offspring outcomes as an aid to further disentangle underlying mechanisms.
The associations of maternal dietary intake during pregnancy with childa€™s dietary intake were also stronger than the associations of maternal postnatal dietary intake, which suggest that in utero mechanisms may play a role in the programming of offspring appetite [100]. Future studies may benefit from detailed assessments of the studied exposures and outcomes throughout the life-course, which could provide further insight into potential underlying mechanisms.
Maternal immune activation yields offspring displaying mouse versions of the three core symptoms of autism.
Maternal influenza infection during pregnancy impacts postnatal brain development in the rhesus monkey.
Her present pregnancy had been uneventful till now and her early pregnancy scans were reported to be normal.On admission, her general condition was poor, and there were signs of hypotension and tachycardia. Also, based on the US Institute of Medicine (IOM) guidelines, approximately 40 % of women gain an excessive amount of weight during pregnancy in Western countries [37]. Higher maternal prepregnancy body mass index and gestational weight gain have been associated with higher leptin and C-peptide levels in cord blood [56a€“59]. However, these associations are less consistent than those for childhood adiposity measures and, if present, seem to be largely mediated by childhood body mass index. These associations were not explained by adjustment for maternal age at delivery, socioeconomic status, sex of offspring, current age, birth weight, gestation at delivery, and gestation at measurement of body mass index. Stronger associations for maternal body mass index suggest direct intrauterine mechanisms, whereas similar or stronger associations for paternal body mass index suggest a role for shared family-based, lifestyle-related characteristics or genetic factors [87]. Altogether, these studies suggest that various measures reflecting a suboptimal dietary status in pregnant women are associated with adverse cardiovascular and metabolic outcomes in offspring.Maternal prepregnancy obesity and excessive gestational weight gain partly reflect maternal fat accumulation, which is important for fetal development [101]. Studies with repeated maternal weight measurements during pregnancy available can identify critical periods of maternal weight gain. Her upper abdomen was soft and non tender while there was guarding and tenderness in lower abdomen. Importantly, the associations of maternal body mass index and gestational weight gain with childhood outcomes seem not to be restricted to maternal obesity or excessive gestational weight gain, but are present across the full-range of maternal body mass index and gestational weight gain.Several studies aimed to identify critical periods of maternal weight during pregnancy for childhood outcomes. Studies comparing associations of maternal and paternal body mass index with childhood body mass index have shown conflicting results [88]. To obtain further insight into the different components associated with offspring outcomes, studies are needed with more detailed measurements of maternal nutritional status, body composition, metabolic and inflammatory measures, pregnancy-related hemodynamic adaptations and fetal growth. Overall, maternal prepregnancy obesity appears to be more strongly associated with adverse fetal outcomes than excessive maternal gestational weight gain [45, 47]. In this study, no information on gestational weight gain or offspring body mass index was available [80].Thus, in line with the associations of maternal prepregnancy obesity and excessive gestational weight gain with childhood outcomes, these adverse maternal exposures are associated with an increased risk of adiposity and cardiovascular and metabolic disease and mortality in the adult offspring. Central fat accumulation is associated with an adverse cardiovascular and metabolic risk profile in adults, including pregnant women [102]. For the offspring outcomes, more detailed measurements of growth, body composition and cardio-metabolic factors, including cardiac structures, endothelial function, pulse wave velocity, lipid spectrums and glucose responses, might also lead to further insight into the underlying growth, vascular and metabolic mechanisms present in the observed associations. In line with these findings, a study among 5908 Dutch mother-offspring pairs showed that independent from maternal prepregnancy weight and weight gain in later pregnancy, early-pregnancy weight gain was associated with an adverse cardio-metabolic profile in childhood [66]. These findings suggest that some of the effects of maternal prepregnancy obesity on offspring outcomes may be through direct intra-uterine mechanisms.Third, Mendelian randomization approaches use genetic variants, known to be robustly associated with the exposure of interest and not affected by confounding, as an instrumental variable for a specific exposure [89]. The metabolic disturbances may involve dyslipidemia and insulin resistance, which leads to higher maternal circulating levels of free fatty acids, amino acids and glucose, which affect placental and fetal development [101]. Since early pregnancy appears to be a critical period for offspring outcomes, studies are needed with detailed maternal measurements from early pregnancy onwards to already assess their influence on placental and embryonic growth and development. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association.
A study among 977 mothera€“child pairs from Greece showed that maternal first trimester weight gain was associated with an increased risk of childhood obesity and a higher childhood diastolic blood pressure [46].
Associations of these genetic variants with the outcomes of interest support causality for these associations.
A small study among 40 pregnant women showed that maternal insulin secretory response in early pregnancy, but not before or later in pregnancy, was associated with increased placental growth [103]. Long-term follow up of participants in observational studies is needed to assess the influence on the risk of obesity and related cardio-metabolic disorders throughout the life-course.


A study among 4091 mother-offspring pairs, showed no association of maternal FTO with childhood fat mass at the age of 9 years [64]. It has been suggested that excessive maternal nutrition to the developing fetus, especially hyperglycemia, may lead to teratogenicity in the first trimester of pregnancy [104, 105]. In addition, it is of interest to conduct follow-up studies of the third generation offspring from these large observational studies, as this may provide further insight into the intergenerational effects of maternal obesity during pregnancy on especially female offspring.Third, further research is needed focused on prevention of adverse health outcomes in offspring through optimizing maternal prepregnancy body mass index, weight gain and diet during pregnancy. These studies suggest that especially maternal weight gain in early pregnancy, when maternal fat accumulation forms a relatively large component of gestational weight gain, may be a critical period for an adverse childhood cardiovascular risk profile.Thus, next to the risks of adverse fetal outcomes, maternal prepregnancy obesity and excessive gestational weight gain may lead to increased risks of adiposity and adverse cardiovascular risk factors in childhood and adolescence.
Thus far, no other Mendelian randomization studies on these specific associations have been performed.Fourth, randomized controlled trials are considered as the golden standard for causality studies. Also, gestational diabetes, glycosuria and higher maternal fasting glucose levels during pregnancy are associated with higher weight and c-peptide levels at birth and body mass index, fat mass level, fasting glucose and insulin levels in the offspring [106a€“110]. Studies are needed to assess the optimal amounts of maternal weight gain for short-term and long-term maternal and offspring health outcomes to further improve the IOM recommendations for gestational weight gain. Because randomized studies are difficult to perform when maternal prepregnancy obesity and excessive gestational weight gain are the major exposures of interest, previous studies focused on influencing determinants of obesity and excessive gestational weight gain, such as dietary factors and physical activity levels [48].
Two sibling comparison studies, conducted in the Pima of Arizona and Sweden, respectively, showed that body mass index and the risk of type 2 diabetes were higher among offspring from mothers with diabetes during pregnancy, as compared to their siblings who were born when the mother did not have diabetes [85, 111].
Identification of specific maternal dietary components associated with offspring health outcomes is needed to improve maternal dietary recommendations during pregnancy. Based on results from randomized controlled trials, it has been suggested that especially dietary interventions during pregnancy may lead to a small reduction in the amount of gestational weight gain [48].
Small observational studies have suggested that, independent from maternal prepregnancy body mass index, higher maternal triglyceride and amino acid levels are associated with a higher birth weight and neonatal fat mass [112a€“115]. Long term follow up of mothers and their children participating in randomized trials focused on improving maternal diet and reducing maternal weight throughout pregnancy will provide insight into the effectiveness of these maternal lifestyle interventions during pregnancy for improving long-term health of offspring. However, whether they also have a beneficial effect on long-term offspring health outcomes remains unclear.
Thus, maternal fat distribution and metabolic profile during pregnancy may have persistent effects on fetal development and cardio-metabolic development in later life.Low grade systemic inflammation may be involved in pathways leading from maternal obesity or excessive gestational weight gain to adverse offspring outcomes. Repeated measures of body mass index and C-reactive protein in relation to all-cause mortality and cardiovascular disease: results from the consortium on health and ageing network of cohorts in Europe and the United States (CHANCES). Obesity is associated with low-grade systemic inflammation and oxidative stress, also during pregnancy [116a€“118]. Additionally, pregnancy itself leads to a state of mild maternal systemic inflammation, which may interact with obesity-mediated inflammatory mechanisms [119a€“122]. Ultrasound was done which showed a bicornuate uterus with a normal right horn and a live 26-27 weeks fetus in the left horn.
It has been shown that maternal inflammatory markers during pregnancy correlate with fetal growth and neonatal fat mass [123, 124], but the effects at older ages are less clear. Leisure time physical activity and long-term cardiovascular and cancer outcomes: the Busselton Health Study.
Epigenetic mechanisms involve a range of modifications to DNA and associated proteins that together regulate gene activity [127]. Environmental influences in early life may induce epigenetic changes, and thereby affect the risk of cardiovascular and metabolic disease in later life [127].
There was an enlarged gravid intact rudimentary horn and brisk bleeding was seen from the prominent blood vessels scattered all over its fundus [Figure 2]. Although animals studies provide support for epigenetic modifications due to maternal obesity or a high fat diet, only few human studies have explored these associations [126]. The horn was connected to the left wall of the uterus just above the cervix by a thick fibrous band and the ipsilateral tube and ovary were stretched over the horn [Figure 3]. Small studies among pregnant women suggested epigenetic changes of placental genes induced by maternal obesity and impaired maternal glucose tolerance [121, 128a€“130]. Louis, pp 201–21923.Ha HK (1999) Computed tomography and magnetic resonance imaging of pathologic conditions of pregnancy.
Also, a human study among 88 mothera€“child pairs suggested that maternal weight gain in early pregnancy, but not maternal prepregnancy body mass index or weight gain in later pregnancy, might be associated with epigenetic modifications in offspring cord blood [131]. Hours lying down per day and mortality from all-causes and cardiovascular disease: the HUNT Study, Norway.
Epigenetic modifications as well as other mechanisms may be involved in adiposity, cardiovascular and metabolic developmental adaptations.Offspring from mothers with prepregnancy obesity or excessive gestational weight gain during pregnancy have higher fetal growth rates and are at increased risk of being born large for their gestational age. The associations of maternal obesity during pregnancy with the risk of obesity in childhood and adulthood may thus be explained by tracking of body size and fatness throughout the life course. However, many observational studies have shown that additional adjustment for birth weight does not explain the observed associations [38].
This might be explained by birth weight not accurately reflecting neonatal fat mass, but might also suggest that other mechanisms play an important role [91]. Pathological evaluation of the specimen confirmed the presence of placenta percreta invading the serosal layer. Animal studies have suggested that altered adipocyte development may influence the development of obesity and insulin resistance in the offspring, as maternal obesity during pregnancy may affect both offspring adipocyte morphology and metabolism [92]. Impact of body size and physical activity during adolescence and adult life on overall and cause-specific mortality in a large cohort study from Iran.
Microscopic examination confirmed the lack of any communication in the fibrous band connecting the rudimentary horn with the uterus.
Next to altered growth and adipocyte function, altered appetite control may be a key factor in developmental programming of obesity. The neonate was discharged from the hospital after one and a half months in a healthy condition after gaining weight up to 1400 g. A maternal hypercalorific diet during pregnancy and overfeeding in the fetal and early postnatal period is associated with adverse programming of the hypothalamus, which may lead to hyperphagia and altered satiety mechanisms [91, 133]. High leptin and insulin levels in the fetal and early postnatal period are thought to play a central role in this adverse hypothalamic programming [91].The associations of maternal prepregnancy body mass index and gestational weight gain with adverse cardiovascular and metabolic outcomes in the offspring appear to be largely mediated through offspring obesity.
Quantifying the contributions of behavioral and biological risk factors to socioeconomic disparities in coronary heart disease incidence: the MORGEN study.
However, direct cardiovascular and metabolic programming effects of maternal obesity during pregnancy may also be present [92]. Animal studies have shown maternal programming effects on cardiovascular and metabolic outcomes. Maternal obesity and high fat diet during pregnancy are associated with high blood pressure, endothelial dysfunction, increased aortic stiffness and cardiac hypertrophy in rodents [92, 134].
A meta-analysis of prospective studies of coffee consumption and mortality for all causes, cancers and cardiovascular diseases.
It has been shown that high blood pressure in offspring occurs, due to selective leptin resistance which increased sympathetic nervous system activity, before the development of increased adiposity levels and hyperleptinaemea, which suggests that the selective leptin resistance was not obesity related but a direct consequence of the exposure to maternal obesity in early life [134]. A detailed history should be taken in every patient on her first visit including any complaints of severe dysmenorrhea.
Increased maternal glucose transport to the developing fetus leads to a higher exposure of glucose for the developing fetal pancreas, which results in acceleration of fetal pancreatic development [92, 133]. However, the rudimentary horn may be underdeveloped and its endometrium non functional and dysmenorrhoea may be absent as seen in our case. This accelerated pancreatic maturation may predispose to premature loss of AY-cells and consequently lead to impaired glucose and insulin homoeostatis [133].
Occupational status and incidences of ischemic and hemorrhagic stroke in Swedish men: a population-based 35-year prospective follow-up study. A careful pelvic examination in the first trimester showing deviated uterus with a palpable adnexal mass should arouse suspicion of a mullerian anomaly. Offspring of female rats and mice fed a high-fat diet during pregnancy have increased triglyceride levels and oxidative stress in the liver, which may predispose to the development of non-alcohol fatty liver disease, the hepatic manifestation of the metabolic syndrome [92].Thus, multiple mechanisms may be involved in the intra-uterine pathways leading from maternal obesity and excessive weight gain during pregnancy to long-term adverse offspring health outcomes. Hazardous alcohol consumption is associated with increased levels of B-type natriuretic peptide: evidence from two population-based studies.
Even then, the placental invasion remained elusive and was diagnosed only at laparotomy.Thus we conclude that high clinical suspicion, early diagnosis and timely laparotomy can reduce the perinatal mortality for both mother and fetus.
When diagnosed early, excision of rudimentary horn with ipsilateral salpingectomy is the recommended surgical treatment and provides the best prognosis. Primary preventive potential of major lifestyle risk factors for acute myocardial infarction in men: an analysis of the EPIC-Heidelberg cohort.
Psychosocial risk factors, weight changes and risk of obesity: the Copenhagen City Heart Study. Informativeness of indices of blood pressure, obesity and serum lipids in relation to ischaemic heart disease mortality: the HUNT-II study. The relative importance of modifiable potential risk factors of type 2 diabetes: a meta-analysis of two cohorts.
Influence of maternal overnutrition and gestational diabetes on the programming of metabolic health outcomes in the offspring: experimental evidence. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999a€“2010.
Maternal overweight and obesity in early pregnancy and risk of infant mortality: a population based cohort study in Sweden. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. Maternal obesity and occurrence of fetal macrosomia: a systematic review and meta-analysis.



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