Obesity and Pregnancy

AI-powered stethoscope doubles success in diagnosing heart failure during pregnancy

Heart failure during pregnancy is a life-threatening and often overlooked condition, primarily because its symptoms—such as shortness of breath, severe fatigue, and difficulty breathing while lying down—closely resemble typical discomforts associated with pregnancy. This confusion often leads to delayed diagnosis. However, a groundbreaking study presented at the European Society of Cardiology Congress, based on research by the Mayo Clinic, demonstrates that an artificial intelligence (AI)-enabled digital stethoscope allowed healthcare providers to diagnose twice as many cases of heart failure compared to conventional obstetric care methods. The full study has been published in Nature Medicine.

This clinical trial was conducted in Nigeria, where pregnancy-related heart failure occurs more frequently than in any other region worldwide. The findings revealed that the AI-enabled stethoscope was 12 times more likely to detect weakened heart function—specifically in cases with an ejection fraction of less than 45%—compared to traditional methods. An ejection fraction under 45% is a critical indicator of peripartum cardiomyopathy, a form of heart failure that can develop during the final months of pregnancy or soon after childbirth.

“Early detection of this form of heart failure is crucial for safeguarding maternal health and wellbeing,” explained Dr Demilade Adedinsewo, a cardiologist at the Mayo Clinic and the lead investigator of the study. “Symptoms of peripartum cardiomyopathy can progressively worsen as pregnancy advances, or more commonly after childbirth. If left undiagnosed and untreated, this condition can become life-threatening as the heart weakens further. Although medications can help when detected early, severe cases may necessitate advanced interventions, including intensive care, mechanical heart pumps, or even heart transplants in extreme situations.”

The randomised, controlled, open-label clinical trial involved nearly 1,200 participants. Each was screened for heart conditions using either standard obstetric care or AI-enhanced tools. Researchers at the Mayo Clinic had previously developed a 12-lead AI-electrocardiogram (ECG) algorithm, capable of predicting a weak heart pump, known clinically as low ejection fraction. This algorithm was further refined by Eko Health, which incorporated it into its point-of-care digital stethoscope. The stethoscope, cleared by the U.S. Food and Drug Administration (FDA), is designed to detect heart failure in patients with low ejection fractions.

The results of the study were compelling. The combination of the AI-based screening tools—comprising the digital stethoscope and the 12-lead ECG—enabled doctors to identify cases of weak heart function with a high degree of accuracy. Specifically, the AI-enhanced stethoscope doubled the number of heart failure cases detected with ejection fractions below 50%, and significantly increased detection rates for ejection fractions under 45%.

The researchers evaluated the AI-enabled screening tools across three different levels of ejection fraction, all of which are used in the clinical diagnosis of heart failure. An ejection fraction below 45% is the threshold for diagnosing peripartum cardiomyopathy, while a measurement below 40% indicates heart failure with reduced ejection fraction, for which specific medications are known to alleviate symptoms and lower the risk of mortality. Ejection fractions below 35% suggest critically low heart pump function, often requiring aggressive management, including advanced heart failure treatments or the implantation of a defibrillator if heart function fails to improve. Each participant in the intervention group underwent an echocardiogram at the start of the trial, which provided confirmation of the AI-predicted heart function.

“This research provides compelling evidence that AI-assisted tools can significantly improve the detection of peripartum cardiomyopathy, especially in Nigerian women, where the condition is more prevalent,” stated Dr Adedinsewo. “However, there are still important questions that need to be addressed. Our next step involves assessing the usability and adoption of these tools by Nigerian healthcare providers, including both doctors and nurses, as well as evaluating the impact of the AI-enabled stethoscope on patient outcomes. In the United States, peripartum cardiomyopathy affects approximately 1 in 2,000 women, but among African American women, the incidence is as high as 1 in 700. Evaluating the effectiveness of this AI tool in the U.S. will further test its capabilities across diverse populations and healthcare environments.”

The clinical trial received financial backing from several sources, including the Mayo Clinic’s Centres for Digital Health and Community Health and Engagement Research, the Mayo Clinic’s Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) programme, which is funded by the National Institutes of Health (NIH), and the Mayo Clinic’s Centre for Clinical and Translational Sciences (CCATS), also funded by the NIH.

The study not only underscores the potential of AI in improving maternal healthcare, but also highlights the critical importance of early diagnosis in preventing life-threatening complications related to heart failure during and after pregnancy. With further refinement and wider implementation, this AI-enhanced tool could transform the way pregnancy-related heart failure is detected and managed, potentially saving countless lives in the process.

Gestational diabetes does not increase breast cancer risk, study finds

A recent study has found that gestational diabetes does not elevate the risk of developing breast cancer, providing reassurance to millions of women worldwide. This significant research will be presented at the upcoming Annual Meeting of the European Association for the Study of Diabetes.

Gestational diabetes, a condition that affects nearly 15% of pregnant women globally, has long been a subject of concern due to its association with various long-term health risks. These include a heightened likelihood of developing type 2 diabetes, metabolic syndrome, cardiovascular disease, chronic kidney disease, and certain mental health conditions. However, the link between gestational diabetes and breast cancer, the most common cancer among women, has remained unclear until now.

Women who are older, living with obesity, or have a family history of diabetes are at a greater risk of developing gestational diabetes. This condition, characterised by insulin resistance, has been the focus of much research due to its potential to trigger a range of health issues.

Dr Maria Hornstrup Christensen, the senior author of the study, emphasised the importance of understanding breast cancer risk factors. “Breast cancer is the most common cancer, as well as the leading cause of cancer deaths in women worldwide. It also has a very high treatment cost compared with other cancer types. If we know who is more likely to develop breast cancer, we might be able to detect it earlier when it is easier to treat, reducing deaths and treatment costs and the psychological and physical toll on women,” she said.

To investigate the potential connection between gestational diabetes and breast cancer, a team of researchers conducted an extensive study involving 708,121 women who gave birth in Denmark. Out of these, more than 24,000 women developed gestational diabetes during one or more of their pregnancies. The health outcomes of these women were tracked over an average period of 11 years, during which 7,609 cases of breast cancer were recorded.

The study’s findings revealed that women who had experienced gestational diabetes were no more likely to develop breast cancer than those who had not. This result is particularly significant given the concern surrounding insulin resistance, a key feature of gestational diabetes, which has also been linked to breast cancer in prior studies.

Dr Christensen remarked on the study’s implications, stating, “It will be reassuring for women who have had gestational diabetes to know that they are not at higher risk of developing breast cancer.”

She added a note of caution, however, highlighting the need for continued vigilance regarding other health risks. “They do, however, need to be alert to the fact that they are at higher risk of some conditions, including type 2 diabetes. And all women, regardless of whether or not they have had gestational diabetes, should be breast aware and check their breasts regularly for changes.”

This research provides a new understanding of the health implications of gestational diabetes, offering relief to many while underscoring the importance of ongoing health monitoring and awareness. The study represents a significant step forward in our understanding of the relationship between gestational diabetes and long-term health outcomes.

Obesity during pregnancy linked to increased risk of infant death

A comprehensive study conducted by a team of statistical researchers across multiple institutions has uncovered a slightly increased risk of sudden unexpected infant death (SUID) in babies born to mothers with obesity. The study, which was published in the prestigious journal JAMA Pediatrics, utilised extensive data from the National Center for Health Statistics (NCHS) to explore this potential link. Additionally, the journal has featured an Editorial Comment that further discusses the implications of the findings.

Previous research has established that maternal obesity during pregnancy is associated with a range of adverse outcomes, including heightened risks of general infant mortality and various maternal and infant health complications. Despite this, the specific connection between maternal obesity and the risk of SUID had not been thoroughly investigated until now.

To delve into this potential association, the research team focused on data from the NCHS covering the years 2015 to 2019, with particular attention to infant deaths occurring within the first year of life. The study considered all live births that occurred at 28 weeks of gestation or later and followed the infants for up to 364 days postpartum. The researchers then conducted a comparative analysis of SUID cases among infants born to mothers with obesity versus those born to mothers without obesity.

The analysis revealed that among the 19 million live births during the study period, 16,545 infants tragically succumbed to SUID. Of these deaths, 5.4% were found to be attributable to maternal obesity during pregnancy. This translates to a SUID rate of 0.74 per 1,000 live births for infants born to mothers without obesity, compared to a significantly higher rate of 1.47 per 1,000 live births for infants born to mothers with obesity.

In addition to the increased risk of SUID, the study also highlighted that mothers with obesity are more prone to experiencing sleep apnoea during pregnancy. Previous research has indicated that sleep apnoea is associated with several pregnancy-related health issues, including preeclampsia—a condition characterised by high blood pressure and potential damage to other organ systems, most often the liver and kidneys. There is also some evidence suggesting that sleep apnoea can adversely affect foetal growth, further compounding the risks associated with maternal obesity.

The research team emphasises the need for further investigation into the link between maternal obesity and SUID, particularly in light of the rising prevalence of obesity among pregnant women. As the number of women with obesity who become pregnant continues to grow, understanding the underlying mechanisms and risk factors becomes increasingly important to inform public health strategies and improve outcomes for both mothers and infants.

Given the serious implications of these findings, the researchers advocate for continued and expanded research in this area to develop more targeted interventions and support systems aimed at reducing the risk of SUID and improving overall maternal and infant health outcomes.

Exploring the role of the Mediterranean diet in mitigating gestational diabetes risk

A recent comprehensive study published in the journal Nutrition & Diabetes delves into the potential impact of the Mediterranean diet (MedDiet) on reducing the incidence of gestational diabetes mellitus (GDM), a prevalent complication during pregnancy characterised by impaired insulin utilisation due to placental hormones.

GDM not only poses immediate health risks to both mother and child during pregnancy, including heightened risk of birth complications and future chronic conditions, but also contributes to longer-term health issues. Consequently, managing blood glucose levels through medical and dietary measures is essential.

Prevailing research underscores the efficacy of dietary and lifestyle changes in the early stages of pregnancy, or even prior, in averting GDM. Diets high in saturated fats, cholesterol, carbohydrates, and total fats are typically linked to a higher GDM risk.

The Mediterranean diet is noted for its emphasis on whole grains, vegetables, legumes, and foods high in monounsaturated fatty acids (MUFAs), while limiting processed and red meats. Instead of isolating individual dietary components, assessing overall dietary patterns like the MedDiet may offer a holistic approach to managing or preventing GDM.

Numerous studies corroborate that a strict adherence to the MedDiet correlates with a reduced risk of GDM. However, a systematic review and meta-analysis are crucial to consolidate these findings comprehensively.

The current review collated studies up to August 2023 from databases such as PubMed, Web of Science, Google Scholar, and Scopus, excluding duplicates, animal studies, ecological studies, short communications, and non-English articles.

From the selected studies—two case-control and eight cohort studies—conducted in diverse locations including the USA, various Mediterranean countries, Australia, Iran, Spain, and Greece, researchers analysed data from over 32 million participants aged 18 to 45.

The Mediterranean Diet Adherence Screener (MEDAS) score, higher quartiles of alternate MED (AMED) score, and the Mediterranean-Style Dietary Pattern Score (MSDPS) were tools used to assess dietary adherence. GDM outcomes were evaluated using criteria from the National Diabetes Data Group, and through fasting or postprandial blood sugar levels, or glucose challenge tests.

Findings from seven out of ten studies reviewed demonstrated a significant link between higher MedDiet adherence and lower GDM risk, although results varied due to differences in study designs or dietary assessment periods.

Interestingly, while case-control studies reported a substantial 75% reduction in GDM risk among women with higher MedDiet adherence, cohort studies indicated a more moderate 20% risk reduction. The larger reductions noted in case-control studies might stem from recall biases, possibly exaggerating the risk reduction.

Subgroup analyses showed that the benefits of MedDiet adherence in reducing GDM risk applied across both Mediterranean and non-Mediterranean populations, suggesting universal applicability of this dietary pattern.

Higher consumption of whole grains, fruits, vegetables, extra virgin olive oil, nuts, and legumes, alongside regular fish and seafood intake, characterises greater adherence to the MedDiet. This diet, rich in antioxidants and vitamins, mitigates oxidative stress and inflammation, critical factors in chronic disease progression.

The diet’s high polyphenol content in fruits and vegetables plays multiple roles in reducing GDM risk, including glucose absorption inhibition in the gastrointestinal tract, anti-inflammatory properties, microbiota modification, and enhanced antioxidant capacity.

Previous meta-analyses have linked greater MedDiet adherence to reduced obesity or overweight risks by 9%, noting that obesity and insulin resistance are significant GDM risk factors. Additionally, whole grains and nuts, rich in MUFAs and polyunsaturated fatty acids (PUFAs), help regulate blood glucose levels and control appetite.

Observational studies have suggested that long-term red meat consumption may increase GDM risk, further supporting the reduced GDM incidence among those adhering to the MedDiet.

The current systematic review and meta-analysis provide strong evidence supporting the MedDiet’s role in reducing GDM risk when followed before or during pregnancy. It is advisable for women of reproductive age to consider the MedDiet to prevent GDM and other adverse pregnancy outcomes.

Further research should explore the interaction between the MedDiet, genetic factors, and lifestyle elements to refine preventive strategies for GDM.

Examining the impact of excess weight on semen quality

A recent systematic review and meta-analysis published in the International Journal of Obesity, conducted by researchers in China, has revealed the profound impacts of obesity and overweight on male fertility. This study delves into the association between Body Mass Index (BMI) and semen quality, indicating significant adverse effects, particularly in men with more severe levels of obesity. 

Approximately 15% of couples of reproductive age worldwide face infertility issues, with male factors, notably poor semen quality, contributing to 20–70% of these cases. Over recent decades, a marked decline in semen quality has been noted globally. For instance, significant decreases in total sperm count and sperm concentration were observed from 1973 to 2011 in Western nations, and from 1981 to 2019 in China. This decline is influenced by various factors including age, lifestyle, and environmental conditions. An increase in abnormal BMI has been pinpointed as a potential risk factor amidst these changes. Previous studies have linked obesity to reductions in semen quality, but results have varied due to differences in BMI classifications and other methodological limitations.

To address these inconsistencies and provide clearer insights, the researchers included data from 50 human studies, involving a total of 71,337 men aged between 26 and 44 years. These studies were sourced from Embase, PubMed, and Web of Science and categorised men based on their BMI: under 25.0 kg/m² as the reference group, 25.0–29.9 kg/m² as overweight, and over 30.0 kg/m² as having obesity. The studies examined various semen parameters such as volume, sperm concentration, motility, total sperm count, and morphology. Men were also categorised based on their fertility status into general, infertile or sub-fertile, and suspiciously sub-fertile groups.

The analysis, employing statistical tools like the random effects model, Cochran’s Q tests, and I² statistics, demonstrated that obesity was associated with significant reductions in several key semen parameters. Men with obesity, for instance, showed reductions of 0.24 ml in semen volume, 19.56 × 10⁶ in total sperm number, and decreases in both total and progressive motility. Men with overweight experienced milder declines, which were not as widespread across different semen parameters.

The study also highlighted that the detrimental effects of obesity on semen quality varied across different global regions, including America, Asia, and Europe, suggesting regional differences in lifestyle and environmental factors could influence the degree of impact. Furthermore, the findings were consistent across different methods of semen assessment, reinforcing the robustness of the results.

Despite its strengths, such as a large sample size and unified BMI classifications, the study faced limitations related to potential inaccuracies in aggregated data and the BMI’s inability to distinguish between muscle and fat mass. Additionally, the traditional semen parameters used might not fully reflect the functional capacity of sperm.

In conclusion, the analysis confirmed a significant association between higher BMI and poorer semen quality, with more severe impacts observed in men with higher obesity classes. These findings emphasise the importance of maintaining a healthy weight to support male reproductive health and suggest that future studies should explore broader reproductive implications of obesity using more comprehensive indicators of sperm health and function.

Lifestyle changes in mothers with obesity could mitigate heart risks in offspring

Researchers at King’s College London have discovered that lifestyle modifications could potentially reduce the risk of children developing certain cardiovascular diseases, which are believed to stem from maternal obesity and related foetal heart abnormalities.

Globally, obesity rates among pregnant women are on the rise, with more than half of the women attending antenatal clinics in England and Wales either having overweight (28.5%) or obesity (22.7%). Studies have increasingly shown that obesity during pregnancy can precipitate cardiovascular complications and disrupt normal cardiac development in the offspring.

The findings were detailed in a recent publication in the International Journal of Obesity, led by Dr Samuel Burden. The research team conducted a systematic review of existing studies to explore whether interventions targeting obesity in pregnant women—through diet, exercise, and other physical activities—can foster cardiac health in their children.

The selection criteria for the studies included randomised trials focusing on lifestyle changes among pregnant women diagnosed with obesity. The evidence reviewed indicated that such interventions could avert atypical cardiac development in children, highlighting several benefits commonly associated with improved heart health, such as decreased thickening of the heart walls, maintaining normal heart weight, and reducing the likelihood of increased heart rates.

Dr Samuel Burden commented, “We and others have demonstrated that maternal obesity correlates with signs of poor heart development in children. Our review of existing literature on dietary and exercise interventions in women with obesity, either before or during pregnancy, revealed that these measures indeed offer a protective shield against the extent of this unhealthy heart development in children. Should these results hold into adulthood, these interventions could shield against the detrimental cardiovascular conditions seen in adult children of mothers with obesity, thus guiding public health strategies to enhance cardiovascular health for future generations.”

Although the data supports the premise that lifestyle adjustments in pregnant women with obesity may safeguard infant cardiovascular health, further comprehensive studies are necessary. These should involve larger cohorts and extend into later childhood to affirm the findings and assess if the benefits continue into adulthood.

Should future research corroborate these findings, the implications could be significant, potentially shaping public health initiatives aimed at improving heart health across generations.

Research reveals fathers’ diet affects child health before birth

A pioneering study conducted by Helmholtz Munich and the German Center for Diabetes Research has shed new light on the significant influence of paternal diet and body mass on the health of future generations even before conception occurs. This groundbreaking research offers vital insights that could lead to the development of targeted preventive health strategies for men planning to father children. The crux of the findings suggests a direct correlation between a father’s nutritional habits and the reduced risk of offspring developing metabolic conditions such as obesity and diabetes in later life.

Dr. Raffaele Teperino, who leads the Environmental Epigenetics research group at Helmholtz Munich, spearheaded this inquiry along with his team. Their research primarily focused on mitochondrial tRNA fragments (mt-tsRNAs) present in sperm, which are crucial in the epigenetic transmission of health characteristics, effectively regulating gene expression that impacts the health trajectory of children.

The empirical evidence was derived from the LIFE Child cohort data, encompassing over 3,000 families. Analysis from this cohort illustrated a clear link between paternal body mass and children’s propensity towards obesity and metabolic diseases, a connection that remains irrespective of maternal weight, genetic factors, or environmental influences.

To corroborate these findings, Dr. Teperino’s team undertook experimental studies on mice. These experiments involved feeding mice a high-fat diet and observing the resultant effects on their reproductive systems, particularly focusing on the epididymis where sperm matures. The findings were striking: offspring of mice fed a high-fat diet exhibited a marked increase in susceptibility to metabolic diseases.

Further laboratory studies involved creating embryos via in-vitro fertilisation using sperm from these diet-affected mice. Remarkably, mt-tsRNAs from the sperm of high-fat diet mice were detected in the early stages of these embryos, significantly altering gene expression which, in turn, influenced the development and health of the resulting offspring.

Professor Martin Hrabě de Angelis, co-author and Research Director at Helmholtz Munich, emphasised the importance of these findings: “Our research confirms that acquired phenotypes, like diabetes and obesity, can be epigenetically transmitted across generations. This underscores epigenetics as a molecular bridge that connects environmental factors with genetic frameworks across generational lines, a process evident not only through maternal lineage but, importantly, through paternal contributions as well.”

This research underscores the critical role of paternal health in the pre-conception phase and presents a compelling case for enhanced preventive health strategies targeting prospective fathers. These strategies, particularly focused on dietary guidance, could significantly mitigate the risk of obesity and diabetes in children, enhancing generational health outcomes.

The study also touches on the broader implications concerning mitochondrial functions. Commonly recognized as cellular powerhouses, mitochondria possess their own DNA (mt-DNA), which orchestrates protein production within mitochondria through mt-RNA and is traditionally inherited maternally. This research brings to light the lesser-known fact that fathers also contribute mt-tsRNAs during fertilisation, which play a role in the epigenetic regulation of gene expression in early embryos. This epigenetic influence by paternal mt-tsRNAs not only underscores their role in shaping the mitochondrial function but also highlights their indirect yet pivotal influence on the metabolic health of their children.

Maternal obesity directly impacts male offspring’s lifelong health

Recent findings reveal that sons born to mothers with obesity are more likely to face a host of health challenges from birth into adulthood, including a predisposition to obesity, liver conditions, and diabetes.

This increased risk is attributed to the unique way male hormones, or androgens, interact with the developmental processes of the liver in male offspring.

A groundbreaking study spearheaded by the University of South Australia (UniSA) delves into the complex effects maternal obesity has on the foetal liver’s response to androgen signalling.

The research highlights a concerning trend: male foetuses carried by women with obesity exhibit altered liver responses to androgens, pushing them towards accelerated growth, often at the cost of their long-term health.

According to UniSA’s Dr Ashley Meakin, androgens play a pivotal role in bestowing male traits and are integral to male development. However, an excess of these hormones can lead to oversized male foetuses. This not only complicates the birthing process but can also lead to lifelong liver function issues.

In contrast, female foetuses seem to have a protective mechanism against the excess testosterone stemming from maternal obesity, effectively dampening the androgen pathway in the liver. This curbs their growth and reduces the likelihood of facing metabolic disorders in later life.

Dr Meakin notes significant gender disparities in the prevalence of metabolic disorders in adulthood, attributing a higher susceptibility to non-alcoholic fatty liver diseases and diabetes in men to maternal obesity during pregnancy, especially if the birth weight exceeds 4 kilograms.

The research team, including study lead Professor Janna Morrison, head of the Early Origins of Adult Health Research Group at UniSA, underscores the critical importance of balanced nutrition during pregnancy. They argue that achieving a “Goldilocks pregnancy” – not too little, not too much, just right – is essential for fostering the best health outcomes for offspring.

Professor Morrison warns of the long-term challenges posed by societal attitudes towards nutrition, emphasising the urgent need to combat obesity and its ripple effects from gestation through to adulthood. She advocates for early education on healthy eating habits, which can have a lasting impact, particularly during pregnancy when optimal nutrition is crucial.

In the meantime, Dr Meakin suggests that dietary supplements might offer a temporary solution to correct nutritional imbalances during pregnancy, ensuring the foetus has the best possible conditions for healthy development.

The study, published in the journal Life Sciences, forms part of a broader investigation by Professor Morrison and her colleagues into the effects of maternal nutrition – both excessive and insufficient – on the developing placenta, heart, lungs, and liver.

Study shows early breastfeeding mitigates child obesity, regardless of maternal weight

A recent study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health has revealed a significant correlation between early breastfeeding and reduced childhood obesity risks. This relationship holds true irrespective of the mother’s pre-pregnancy body mass index (BMI).

The ECHO Cohort study delved into the impact of breastfeeding practices in women who had overweight or obesity before pregnancy and its influence on their children’s BMIz scores. BMIz scores are used to compare a child’s height and weight against their peers, whereas BMI assesses body weight relative to height.

The research discovered that any consistent breastfeeding during the first three months of an infant’s life was linked with lower BMIz scores at ages 2 to 6, regardless of the mother’s pre-pregnancy BMI. This association was particularly pronounced in children whose mothers had obesity before pregnancy, compared to those whose mothers were merely overweight.

Dr. Gayle Shipp from Michigan State University, who led the study, emphasised the importance of each additional month of breastfeeding, whether exclusive or combined with other foods, in contributing to lower childhood weights. This effect was notably significant for mothers who had overweight or obesity before pregnancy.

The study analysed data from 8,134 mother-child pairs across 21 sites in 16 states and Puerto Rico. It examined BMI and BMIz scores obtained from study visits, medical records, or self-reported information. The research particularly focused on two aspects of breastfeeding: whether the mother ever breastfed and if she was exclusively breastfeeding at three months. The definition of continuous breastfeeding included any breastfeeding duration with the allowance of formula or other food, and the duration of exclusive breastfeeding without formula feeding or other food.

The study found that exclusive breastfeeding at three months was linked to a lower child BMIz score primarily among women with a normal pre-pregnancy BMI. Each additional month of either any or exclusive breastfeeding correlated with a significantly lower child BMIz score, especially for mothers who had overweight or obesity before pregnancy.
Dr. Shipp highlighted the significance of this research for health professionals, suggesting it as an opportunity to promote breastfeeding among all women, particularly those with obesity. The study’s findings have been published in the journal Pediatrics.

New study finds obesity in pregnancy raises risk of future heart disease

The link between maternal obesity and the long-term risk of cardiovascular disease has been further solidified by new research findings. A study led by Northwestern University in the United States has shone a light on the significant health risks faced by women who enter pregnancy with obesity.

The research team discovered that women with obesity before conception are more susceptible to complications during pregnancy than their counterparts with healthier pre-pregnancy weights. These complications include conditions like pre-eclampsia and gestational diabetes, which have previously been associated with an increased risk of heart disease later in life.

The study’s principal investigator, Dr. Sadiya Khan, emphasised that while these pregnancy-related issues can indeed signal future cardiovascular problems, they are not the underlying cause of heart disease. Instead, they merely highlight pre-existing risk factors that become apparent during the metabolic and physical demands of pregnancy.

To reach these conclusions, the researchers analysed health data from 4,216 women who were giving birth for the first time. They observed that those with higher body mass indices (BMIs) in the first trimester had an elevated risk of developing hypertensive disorders during pregnancy than those with BMIs within the normal range.

Dr. Khan explained that the study approached pregnancy as a ‘natural stress test’ for the heart, which could expose pre-existing health concerns. The implications of these findings underscore the importance of addressing pre-pregnancy obesity with proactive health interventions rather than waiting for cardiovascular events to occur.

The research team is advocating for healthcare providers to emphasise the importance of a nutritious diet and regular physical activity during prenatal visits. While weight loss is not recommended during pregnancy, guidance and support for maintaining an appropriate weight gain during this period are crucial.

The study also presented quantitative insights, revealing that among the participants, 4% had gestational diabetes and 15% encountered complications due to high blood pressure.

These findings, which align with prior research advocating for weight management during pregnancy through diet and exercise, have been published in the journal Circulation Research, providing valuable insights for expectant mothers and healthcare professionals alike.

Rising obesity levels may intensify menopause symptoms and reduce hormone therapy efficiency, preliminary study indicates

The global surge in obesity, with an estimated 13% of adults now grappling with the condition, is a growing concern. A recent report suggests that obesity prevalence is higher among women than men (15% vs. 11%), with a more pronounced incidence in developed nations. Particularly in the United States, data from the Centers for Disease Control and Prevention (CDC) reveals that in 2020, 41.9% of individuals aged 20 and over were categorised as having obesity.

The far-reaching health implications of obesity are well-documented, encompassing a higher propensity for heart attacks, strokes, type 2 diabetes, respiratory ailments, and musculoskeletal issues.

A nascent study unveils a potential additional concern: obesity might amplify the severity of menopausal symptoms and compromise the effectiveness of hormone therapy aimed at alleviating these symptoms. The study’s lead author, Dr. Anita Pershad from the Eastern Virginia Medical School, shared her insights stating, “The core inference from our study is that obesity might exacerbate a woman’s menopausal symptoms while concurrently diminishing the relief provided by hormone therapy (HT).”

However, Dr. Kara McElligot, a NAMS-certified menopause practitioner and medical advisor at Mira, underscored the preliminary nature of this investigation, which encompassed a mere 119 participants and was executed retrospectively via chart review, thus inheriting a higher risk of bias.

The research, though yet to be peer-reviewed, was showcased at the 2023 Annual Meeting of The Menopause Society in Philadelphia, held between September 27 and 30. The study, spanning five years, meticulously reviewed the medical records of 119 women visiting a menopause clinic. These women were segregated into two cohorts based on their Body Mass Index (BMI)—those with a BMI above 30 were categorised as having obesity, while those below this threshold formed the other group.

The evaluation revealed no substantial disparity between the groups concerning age, the extent of menopause, hormone therapy utilisation, and acceptance. However, a significant finding emerged: women with obesity exhibited a higher propensity to report symptoms such as vasomotor symptoms (hot flashes), genitourinary/vulvovaginal symptoms, mood fluctuations, and diminished libido.

Dr. Sherry Ross, a seasoned OB/GYN at Providence Saint John’s Health Center in Santa Monica, elucidated a plausible cause, positing that women with obesity might experience intensified hot flashes and night sweats as fatty tissues could act as insulators, retaining heat within the body. Another theory proposes that obesity might trigger hormonal imbalances, thus engendering elevated oestrogen levels which, in turn, could exacerbate menopausal symptoms.

Dr. Ashley Parr, D.O., OB/GYN at The Women’s Hospital at MemorialCare Saddleback Medical Center, concurred with this notion, adding that the oestrogen-producing capability of fat cells could potentially alter the hormonal equilibrium of women with obesity during menopause, even post the cessation of ovarian function.

Moreover, the research identified a diminished likelihood of symptomatic relief post systemic and/or localised hormone therapy among women with obesity, compared to their counterparts without obesity. Dr. Pershad disclosed ongoing inquiries into the ambiguous efficacy of hormone therapy among women with obesity.

She further discussed exploring alternative designs and administration routes to potentially enhance hormone therapy effectiveness. Concurrently, Dr. Parr highlighted that obesity-associated risks for other health conditions like heart disease and breast cancer could deter the choice of hormone replacement, prompting considerations for non-hormonal treatment alternatives such as SSRIs, SNRIs, and vaginal oestrogen based on the specific symptoms sought to be addressed.

Dr. McElligot delineated the conceivable reasons behind the diminished effectiveness of hormone therapy in women with obesity, referring to various factors influencing the severity and experience of oestrogen deficiency, with obesity being a prime contender. She also brought attention to liver drug metabolism studies that reveal variations in circulating drug quantities based on BMI among adults, shedding light on the possible need for revising hormone therapy dosing recommendations to cater to the distinct metabolic dynamics presented by obesity.

Pioneering digital health startups target U.S. maternal health challenges

The escalating maternal health crisis in the U.S., highlighted by a disconcerting 40% surge in maternal deaths during or shortly after pregnancy to 1,205 in 2021, is instigating an urgent response from the digital health sector. Startups like Pomelo Care, Maven Clinic, and Babyscripts are harnessing virtual services to bridge the maternal care gaps and mitigate pregnancy-related complications, according to the National Center for Health Statistics.

This alarmingly high mortality rate was a significant topic at The Wall Street Journal Health Forum in March. Here, Chelsea Clinton, through her venture-capital firm Metrodora Ventures, stressed the imperative need for intensified support towards women’s health. Clinton is an investor in Oula Health, a startup that’s diving into the sphere of maternal care.

Reports from the Centers for Disease Control and Prevention suggest that 80% of pregnancy-related deaths in the U.S. could have been prevented. Major underlying causes of these fatalities include mental health disorders, heart conditions, and hypertensive disorders during pregnancy.

Digital health startups aim to leverage telehealth and app technologies to identify and manage these health conditions proactively, thereby preventing potentially fatal complications. While technology isn’t the panacea, it undeniably enhances access to medical services and compensates for the scarcity of healthcare professionals, thereby promoting equitable care delivery.

Dr. Kathaleen Barker, an Assistant Professor of Obstetrics and Gynecology at UMass Chan Medical School-Baystate, emphasised the role of technology in equalising access to prenatal care. Baystate Health, a healthcare system in Western Massachusetts, utilises Babyscripts technology.

Investor-backed Babyscripts, headquartered in Washington D.C., collaborates with over 70 U.S. health systems. Co-founder and Chief Executive Anish Sebastian stated that Babyscripts, also known as 1EQ, offers patients a blood-pressure monitor that pairs with an app via Bluetooth. This technological intervention aims to preempt conditions such as preeclampsia, a condition characterised by high blood pressure and signs of liver or kidney damage that can arise after the 20th week of pregnancy.

Pomelo Care, a New York-based virtual clinic, aims to supplement in-person care by providing services between doctors’ appointments. Having secured $33 million in seed and Series A funding led by Andreessen Horowitz, Pomelo Care assigns a nurse to each patient to oversee their care. After assessing the patient’s needs and health claims data, the nurse assembles a personalised care team.

Pomelo Care operates on a value-based business model that encourages improving patient access to care, enhancing outcomes, and reducing costs. The company plans to validate its effectiveness through studies conducted in collaboration with insurers and academic medical centres, with the findings set to be published.

Another player in the field, Maven Clinic, grants virtual access to an array of services, such as doulas, midwives, physical therapists, and mental health care. Maven has devised a tool to screen for social needs like access to housing, food, and essentials for the family and baby.

The stark truth is that women’s health has been neglected in the U.S., resulting in many women living in maternal-care deserts where access to services is challenging. The conversation about this issue is just starting at the national level, noted Kate Ryder, founder, and CEO of Maven Clinic. However, these innovative digital health startups are undoubtedly setting the stage for a more promising, tech-driven future in maternal healthcare.