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Studying whether girth affects birth

By Kristen Garner

Could the obesity epidemic in the United States be affecting newborns? Diabetes, high blood pressure, and heart disease are just some of the health problems associated with obesity in adults, but they usually tend to arise later in life. Juliette Madan, M.D., a Dartmouth neonatologist, has been exploring how obesity in young women of child-bearing age may affect their babies.

She and her team were able to take a historical look at the question thanks to a database of information collected on pregnant women in New England over the past 25 years. First, they determined that, just as is true of the population as a whole, pregnant women today are heavier on average than pregnant women in the 1980s. In fact, 60% of New England mothers-to-be are now overweight or obese.

She suspected that maternal obesity could increase prematurity.

Database: And what about their babies? "Many of the full-term babies who we cared for who had significant difficulties around the time of birth happen to be delivered to mothers who were obese," Madan says. These were babies whom doctors hadn't expected to have problems. So, to determine if this observation was real, Madan's team used the database to compare mothers' weights to their babies' Apgar scores. An Apgar score (named after the physician who developed it) is an assessment of a baby's health at birth; a high score indicates a healthy baby and a low score means the baby requires medical attention. Madan found that, indeed, babies with lower Apgar scores were more likely to have obese mothers.

She also suspected that maternal obesity could increase the risk of having a premature baby. To address this question, her team again mined the database and was able to show that premature babies were, in fact, more likely to have been born to obese women. Madan thinks the reasons for this are very complex.

High blood pressure is one likely culprit, but Madan believes there are other causes, too. One may be inflammation. Obese people have been shown to have more inflammatory molecules in their bodies, and this is thought to contribute to some of their health problems, such as diabetes and heart disease. Madan has looked at the levels of inflammatory molecules in blood samples from pregnant women and found that they are higher in obese pregnant women than in normal-weight pregnant women.

Link: This finding lays the groundwork for what Madan believes is the next step: studies to determine if the heightened inflammation actually causes some of the complications seen in babies. If there is a causal link, not just a correlation, perhaps doctors can intervene. Ideally, Madan says, physicians like to help mothers get to a normal weight before they become pregnant. But that can be a challenge. So in an imperfect world, she says, "there may be some medications that might be utilized to decrease some of the systemic inflammation that could be affecting the mother—and the baby."

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