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Journal ArticleDOI

Is obesity still increasing among pregnant women? Prepregnancy obesity trends in 20 states, 2003-2009.

TL;DR: Overall, prepregnancy obesity prevalence continues to increase and varies by race-ethnicity and maternal age and the need to address obesity as a key component of preconception care, particularly among high-risk groups is highlighted.
About: This article is published in Preventive Medicine.The article was published on 2013-06-01 and is currently open access. It has received 236 citations till now.
Citations
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Journal ArticleDOI
TL;DR: The article presents the latest data and trends in maternal mortality and severe maternal morbidity, as well as on maternal substance abuse and mental health disorders during pregnancy, two relatively recent topics of interest in the Division of Reproductive Health.
Abstract: This article provides a brief overview of the work conducted by the Division of Reproductive Health at the Centers for Disease Control and Prevention on severe maternal morbidity and mortality in the United States. The article presents the latest data and trends in maternal mortality and severe maternal morbidity, as well as on maternal substance abuse and mental health disorders during pregnancy, two relatively recent topics of interest in the Division, and includes future directions of work in all these areas.

319 citations

Journal ArticleDOI
TL;DR: The adverse consequences for infants born at 38 and 39 weeks gestation are also of a higher risk than those for infants Born at 40 weeks gestation, with the neonatal mortality risk increasing again in infants born beyond the 42nd week of gestation.

268 citations

Journal ArticleDOI
TL;DR: The results of this population-based cohort study can inform prepregnancy weight loss counseling by defining achievable weight loss goals for patients that may reduce their risk of poor perinatal outcomes.

267 citations

Journal ArticleDOI
TL;DR: Health care providers should be aware that women who are obese when they become pregnant are more likely to experience elevated antenatal and postpartum depression symptoms than normal-weight women, with intermediate risks for overweight women.

218 citations

Journal ArticleDOI
TL;DR: Maternal MAE rates overall have remained unchanged while cardiogenic shock, utilization of mechanical circulatory support, and in‐hospital mortality have increased during the study period.
Abstract: Background The reported incidence of peripartum cardiomyopathy (PPCM) in the United States varies widely. Furthermore, limited information is available on the temporal trends in incidence and outcomes of PPCM. Methods and Results We queried the 2004-2011 Nationwide Inpatient Sample databases to identify all women aged 15 to 54 years with the diagnosis of PPCM. Temporal trends in incidence (per 10 000 live births), maternal major adverse events (MAE; defined as in-hospital mortality, cardiac arrest, heart transplant, mechanical circulatory support, acute pulmonary edema, thromboembolism, or implantable cardioverter defibrillator/permanent pacemaker implantation), cardiogenic shock, and mean length of stay were analyzed. From 2004 to 2011, we identified 34 219 women aged 15 to 54 years with PPCM. The overall PPCM rate was 10.3 per 10 000 (or 1 in 968) live births. PPCM incidence increased from 8.5 to 11.8 per 10 000 live births ( P trend<0.001) over the past 8 years. MAE occurred in 13.5% of patients. There was no temporal change in MAE rate, except a small increase in in-hospital mortality and mechanical circulatory support ( P trend<0.05). Cardiogenic shock increased from 1.0% in 2004 to 4.0% in 2011 ( P trend<0.001). Mean length of stay decreased during the study period. Conclusion From 2004 to 2011, the incidence of PPCM has increased in the United States. Maternal MAE rates overall have remained unchanged while cardiogenic shock, utilization of mechanical circulatory support, and in-hospital mortality have increased during the study period. Further study of the mechanisms underlying these adverse trends in the incidence and outcomes of PPCM are warranted.

216 citations

References
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Journal ArticleDOI
20 Jan 2010-JAMA
TL;DR: The increases in the prevalence of obesity previously observed do not appear to be continuing at the same rate over the past 10 years, particularly for women and possibly for men.
Abstract: Results In 2007-2008, the age-adjusted prevalence of obesity was 33.8% (95% confidence interval [CI], 31.6%-36.0%) overall, 32.2% (95% CI, 29.5%-35.0%) among men, and 35.5% (95% CI, 33.2%-37.7%) among women. The corresponding prevalence estimates for overweight and obesity combined (BMI 25) were 68.0% (95% CI, 66.3%-69.8%), 72.3% (95% CI, 70.4%-74.1%), and 64.1% (95% CI, 61.3%66.9%). Obesity prevalence varied by age group and by racial and ethnic group for both men and women. Over the 10-year period, obesity showed no significant trend among women (adjusted odds ratio [AOR] for 2007-2008 vs 1999-2000, 1.12 [95% CI, 0.89-1.32]). For men, there was a significant linear trend (AOR for 2007-2008 vs 1999-2000, 1.32 [95% CI, 1.12-1.58]); however, the 3 most recent data points did not differ significantly from each other.

7,730 citations


"Is obesity still increasing among p..." refers background in this paper

  • ...Recent evidence among non-pregnant women ages 20–39 years suggests that obesity prevalence has plateaued, but we do not know whether this is true among pregnant women (Flegal et al., 2010)....

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  • ...NHANES data do not indicate an increase in obesity among women aged 20–39 years during 1999–2008 (Flegal et al., 2010)....

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Book
01 Jan 2000
TL;DR: The fundamental causes of the obesity epidemic are sedentary lifestyles and high-fat energy-dense diets, both resulting from the profound changes taking place in society and the behavioural patterns of communities as a consequence of increased urbanization and industrialization and the disappearance of traditional lifestyles.
Abstract: This report issues a call for urgent action to combat the growing epidemic of obesity, which now affects developing and industrialized countries alike. Adopting a public health approach, the report responds to both the enormity of health problems associated with obesity and the notorious difficulty of treating this complex, multifactorial disease. With these problems in mind, the report aims to help policy-makers introduce strategies for prevention and management that have the greatest chance of success. The importance of prevention as the most sensible strategy in developing countries, where obesity coexists with undernutrition, is repeatedly emphasized. Recommended lines of action, which reflect the consensus reached by 25 leading authorities, are based on a critical review of current scientific knowledge about the causes of obesity in both individuals and populations. While all causes are considered, major attention is given to behavioural and societal changes that have increased the energy density of diets, overwhelmed sophisticated regulatory systems that control appetite and maintain energy balance, and reduced physical activity. Specific topics discussed range from the importance of fat content in the food supply as a cause of population-wide obesity, through misconceptions about obesity held by both the medical profession and the public, to strategies for dealing with the alarming prevalence of obesity in children. "...the volume is clearly written, and carries a wealth of summary information that is likely to be invaluable for anyone interested in the public health aspects of obesity and fatness, be they students, practitioner or researcher." - Journal of Biosocial Science

5,188 citations

Journal ArticleDOI
TL;DR: These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.
Abstract: To revise 1998 recommendations on childhood obesity, an Expert Committee, comprised of representatives from 15 professional organizations, appointed experienced scientists and clinicians to 3 writing groups to review the literature and recommend approaches to prevention, assessment, and treatment. Because effective strategies remain poorly defined, the writing groups used both available evidence and expert opinion to develop the recommendations. Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. The writing groups also recommend changing office systems so that they support efforts to address the problem. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child’s obesity risk. For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. For assessment, the recommendations include methods to screen for current medical conditions and for future risks, and methods to assess diet and physical activity behaviors. For treatment, the recommendations propose 4 stages of obesity care; the first is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient’s age and degree of excess weight. These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.

4,272 citations


"Is obesity still increasing among p..." refers methods in this paper

  • ...We categorized adolescent women as underweight ( 5th BMIfor-age percentile), normal weight (5th–84.9th BMI-for-age percentile), overweight (85th– 94.9th BMI-for-age percentile), and obese (>95th BMI-for-age percentile) (Barlow and Expert, 2007)....

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  • ...9th BMI-for-age percentile), and obese (≥95th BMI-for-age percentile) (Barlow and Expert, 2007)....

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Journal ArticleDOI
01 Feb 2012-JAMA
TL;DR: The most recent estimates of obesity prevalence in US children and adolescents for 2009-2010 are presented and trend analyses over a 12-year period indicated a significant increase in obesity prevalence between 1999-2000 and 2009- 2010 in males aged 2 through 19 years but not in females.
Abstract: Context: The prevalence of childhood obesity increased in the 1980s and 1990s but there were no significant changes in prevalence between 1999-2000 and 2007-2008 in the United States.

3,941 citations


"Is obesity still increasing among p..." refers background or methods in this paper

  • ...9th BMI-for-age percentile and in the 97th or higher BMI-for-age percentile (Ogden et al., 2012)....

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  • ...For subanalyses, we assessed trends among adolescents in the 95th–96.9th BMI-for-age percentile and in the 97th or higher BMI-for-age percentile (Ogden et al., 2012)....

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Journal ArticleDOI
TL;DR: Obesity has increased at an alarming rate in the United States over the past three decades and the associations of obesity with gender, age, ethnicity, and socioeconomic status are complex and dynamic.
Abstract: This review of the obesity epidemic provides a comprehensive description of the current situation, time trends, and disparities across gender, age, socioeconomic status, racial/ethnic groups, and geographic regions in the United States based on national data. The authors searched studies published between 1990 and 2006. Adult overweight and obesity were defined by using body mass index (weight (kg)/height (m) 2 ) cutpoints of 25 and 30, respectively; childhood ‘‘at risk for overweight’’ and overweight were defined as the 85th and 95th percentiles of body mass index. Average annual increase in and future projections for prevalence were estimated by using linear regression models. Among adults, obesity prevalence increased from 13% to 32% between the 1960s and 2004. Currently, 66% of adults are overweight or obese; 16% of children and adolescents are overweight and 34% are at risk of overweight. Minority and low-socioeconomic-status groups are disproportionately affected at all ages. Annual increases in prevalence ranged from 0.3 to 0.9 percentage points across groups. By 2015, 75% of adults will be overweight or obese, and 41% will be obese. In conclusion, obesity has increased at an alarming rate in the United States over the past three decades. The associations of obesity with gender, age, ethnicity, and socioeconomic status are complex and dynamic. Related population-based programs and policies are needed.

2,780 citations


"Is obesity still increasing among p..." refers background in this paper

  • ...Records excluded because of missing data were disproportionately young, Hispanic, had two or more previous live births, had completed fewer than 12 years of education, were unmarried, nonsmokers, and enrolled in WIC and Medicaid (P 0.001)....

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  • ...A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript Table 1 Maternal characteristics among consistently reporting US states (20 states), 2003, 2006 and 2009a. Characteristic 2003 2006 2009 P-value Maternal age (y) <0.001 <20 9.2 (0.3) 9.1 (0.3) 9.0 (0.3) 20–24 25.5 (0.4) 23.7 (0.4) 22.8 (0.4) 25–29 27.3 (0.4) 28.9 (0.4) 30.1 (0.4) 30–34 24.7 (0.4) 23.9 (0.4) 24.4 (0.4) ≥35 13.4 (0.3) 14.4 (0.3) 13.8 (0.3) Maternal race–ethnicity <0.001 Non-Hispanic White 69.1 (0.3) 66.9 (0.4) 64.9 (0.4) Non-Hispanic Black 13.1 (0.3) 13.1 (0.3) 13.6 (0.2) Hispanic 11.3 (0.3) 12.6 (0.3) 13.1 (0.3) American Indian/Alaskan Native 1.2 (0.1) 1.3 (0.1) 1.3 (0.1) Asian/Pacific Islander 4.9 (0.1) 5.1 (0.2) 5.0 (0.1) Other 0.4 (0.1) 1.1 (0.1) 2.1 (0.1) Parity 0.16 0 41.2 (0.5) 40.8 (0.5) 40.7 (0.5) 1 32.1 (0.4) 31.9 (0.4) 33.2 (0.4) ≥2 26.7 (0.4) 27.2 (0.4) 26.1 (0.4) Maternal education (y) <0.001 <12 15.6 (0.4) 15.2 (0.3) 14.3 (0.3) 12 31.9 (0.4) 29.1 (0.4) 26.7 (0.4) ≥13 52.5 (0.5) 55.8 (0.4) 59.0 (0.5) Married 67.2 (0.4) 65.8 (0.4) 62.5 (0.4) <0.001 WIC enrolled 39.0 (0.4) 40.3 (0.4) 44.5 (0.5) <0.001 Medicaid enrolled 40.1 (0.4) 43.0 (0.4) 46.8 (0.5) <0.001 Smoking before pregnancy 24.5 (0.4) 24.5 (0.4) 26.9 (0.4) <0.001 Abbreviations: WIC, Special Supplemental Nutrition Program for Women, Infants, and Children. a Values are weighted percentages (standard error)....

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  • ...We defined WIC enrollment as having received WIC assistance during pregnancy....

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  • ...Results Across the study period, respondents were predominantly non-Hispanic white, married, post-high school, not enrolled in WIC or Medicaid, and nonsmokers before pregnancy (Table 1)....

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  • ...We used Medicaid and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollment as dichotomous proxy indicators of socioeconomic status....

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