Obesity and Chronic Hypertension: Key Factors in Stillbirth and Perinatal Death Risk and Delivery Decisions, Study Reveals

Canada: A retrospective cohort study published in the American Journal of Obstetrics and Gynecology revealed that pre-pregnancy obesity increases the risk of stillbirth and perinatal death, especially in women with chronic hypertension. However, between 26-35 weeks, this trend reversed, with hypertensive women having a lower stillbirth risk at higher BMIs.

At 31 weeks, women with a body mass index (BMI) of 40 kg/m² had a lower stillbirth risk than those with a BMI of 20 kg/m². The study suggests that optimal delivery timing for obese women may vary based on chronic hypertension status.

Obesity is a known risk factor for stillbirth and perinatal death and is commonly linked to chronic hypertension. However, limited research exists on the connection between pre-pregnancy BMI and gestational age (GA)-specific rates of stillbirth and perinatal death in women with chronic hypertension. To fill this knowledge gap, Jeffrey N Bone, University of British Columbia and the Children’s and Women’s Hospital and Health Centre of British Columbia, Vancouver, BC, Canada, and colleagues aimed to explore the relationship between pre-pregnancy BMI and GA-specific risks of stillbirth and perinatal death, considering the presence or absence of chronic hypertension.

For this purpose, the researchers conducted a retrospective cohort study of all singleton births in the United States during 2016-17, using data from live birth and fetal death certificates provided by the National Center for Health Statistics. They applied Piecewise Additive Mixed Models to evaluate the gestational age (GA)-specific relationship between pre-pregnancy BMI and the risks of stillbirth and perinatal death in women with and without chronic hypertension, adjusting for potential confounders. Results were presented as GA-specific adjusted hazard ratios (aHR) with 95% confidence intervals (CI).

The study led to the following findings:

  • A total of 7,365,797 women were included in the study. Among these, 3.5% were underweight, 43.9% had normal BMI, 26.1% were overweight, and 14.5%, 7.0%, and 5.0% had obesity class I, II, and III, respectively.
  • Stillbirth rates were higher with increasing BMI and were notably higher in women with chronic hypertension (14.2 per 1000 births) compared to those without (4.7 per 1000 births).
  • The cumulative incidence of stillbirth increased with each gestational week and showed a higher gradient with increasing BMI in women without chronic hypertension.
  • In women with chronic hypertension, the relationship between higher BMI and stillbirth risk reversed between 26-35 weeks of gestation.
  • At 31 weeks of gestation, the adjusted hazard ratio (aHR) for stillbirth in women with a BMI of 40 kg/m² vs 20 kg/m² and chronic hypertension was 0.78.
  • Conversely, the aHR for women without chronic hypertension in the same BMI comparison was 1.39.
  • There were similar patterns for perinatal death.

The researchers concluded that the relationship between pre-pregnancy BMI and stillbirth risk is influenced by the presence of chronic hypertension between 26-35 weeks of gestation. During this period, elevated BMI is linked to a lower or similar relative risk of stillbirth and perinatal death. However, women with chronic hypertension and elevated BMI continue to face higher absolute risks of stillbirth and perinatal death across all gestational periods.

“These findings suggest that optimal delivery timing for obese women may depend on whether chronic hypertension is present,” the researchers wrote.

Reference:

Bone JN, Ks JOSEPH, Laura A MAGEE, Chantal MAYER, Sarka LISONKOVA. Relationship between pre-pregnancy body-mass-index and gestational age-specific risk of stillbirth and perinatal death in women with chronic hypertension. Am J Obstet Gynecol. 2024 Dec 12:S0002-9378(24)01184-0. doi: 10.1016/j.ajog.2024.12.007. Epub ahead of print. PMID: 39674332.

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Extreme heat linked to increased postpartum depression among pregnant women who had higher air pollution exposure: Study

Exposure to extreme heat has been shown to impact mental health in previous epidemiological studies but there are a very limited number of studies that investigate the relationship between high-temperature exposure and mental health among pregnant women and no past study explored its impact on postpartum maternal mental health.

To address this knowledge gap, a study recently published in the journal Environmental Health Perspectives led by Jun Wu, PhD, professor of environmental & occupational health at UC Irvine Joe C. Wen School of Population & Public Health, and team found that a cohort of mothers in Southern California that were exposed to higher temperature during the postpartum period was associated with an increased risk for postpartum depression (PPD).

“Our finding builds upon our team’s previous work connecting long-term exposure to air pollution and the increased risk for PPD,” says Wu. “Air pollution and heat make a harmful combination on our bodies as rising temps can stimulate our body to absorb more air pollution through sweat, increased skin blood flow, and breathing more.”

The team conducted a retrospective cohort study of data from over 430,000 women in the Kaiser Permanente Southern California electronic health records who had live singleton births at KPSC facilities between Jan. 1, 2008, and Dec. 31, 2018. The health data was paired with historical daily ambient temperature data that included the amount of air pollution (fine particulate matter and ozone), exposure to green space within 500 meters, and access to air conditioning.

“We found that temperature related PPD risks were greater among African American, Asian, and Hispanic mothers compared with their counterparts,” shares Yi Sun, PhD, the first author of the study. “Higher temperature also showed a stronger association with PPD among mothers who had higher air pollution exposure, lower greenspace levels, and lower access to air conditioning.”

Wu’s previous work has shown that exposure to green space was associated with a reduced risk of postpartum depression (PPD). Additional targeted interventions are needed for mothers, especially those of marginalized communities, exposed to higher temperatures and temperature ranges and living in regions with higher air pollution, lower green space levels, and less access to AC across the State of California.  

Reference:

Buchwald A, Boudova S, Invited Perspective: Climate Change and Maternal Mental Health—Looking beyond High-Income Countries, Environmental Health Perspectives, 10.1289/EHP16476, 132, 11, (2024)

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Homeopathic doctor abducted for Rs 20 lakh ransom, held captive for 2 days

In a shocking incident, a homoeopathic doctor was allegedly kidnapped, held hostage for two days, and coerced into paying a ransom of Rs 7 lakh. Three men, including a D Pharma graduate who is believed to be the mastermind, have been arrested in connection with the case.

It was revealed that the kidnappers demanded Rs 20 lakh from the doctor, however, he negotiated it down and the accused were able to siphon off only Rs 7 lakh. After extorting the money, they abandoned the doctor, which led to the case being registered and an investigation being launched.

For more information, click on the link below:

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Income tax raids prominent IVF centre in Ludhiana

The Income Tax Department on the morning of December 18, 2024, raided both the residence and hospital of Dr Sumita Sofat, a prominent fertility expert in Ludhiana, Punjab. The raids were conducted in connection with an alleged tax fraud case, with officials investigating and reviewing various documents related to Dr Sofat’s medical practice.

The raid comes after allegations of tax evasion surfaced, prompting the Income Tax Department to take action. Sources have indicated that the investigation is in its early stages, and officials are scrutinizing financial documents to uncover any discrepancies or evidence of fraudulent activities.

For more information, click on the link below:

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Drinking a moderate amount of wine may lower the risk of serious cardiovascular disease in high-risk people

Drinking a small or moderate amount of wine may lower the risk of serious cardiovascular disease in people at a higher risk who are following a Mediterranean diet, according to research published in the European Heart Journal.

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Women often told that severity of medical abortion pain no worse than period cramps, survey reveals

Women opting for a medical abortion at home are often advised that the procedure is likely to be no more painful than period cramps, suggest the results of a survey, carried out by the British Pregnancy Advisory Service (BPAS), and published online in the journal BMJ Sexual & Reproductive Health.

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Air pollution linked to increased hospital admissions for mental/physical illness

Cumulative exposure to air pollution over several years is linked to a heightened risk of admission to hospital for mental/behavioral and physical illness, finds Scottish research published in the open access journal BMJ Open.

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Child cash benefits improve child health and development across the globe, study finds

Looking at programs from more than 140 countries, a University of Michigan-led study concludes that large-scale, government-funded child cash transfer programs improve child health outcomes.

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Researchers reveal risks of tisa-cel therapy for relapsed or refractory B-cell lymphomas

Chimeric antigen receptor (CAR) T-cell therapy is a type of cancer immunotherapy where patients’ T-cells are collected and genetically modified to produce chimeric antigen receptors that recognize specific targets on cancer cells, allowing these T-cells to locate and destroy the cancer cells.

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PMJAY Fraud: Khyati Hospital misused emergency tags for Rapid Medical Approvals

Ahmedabad: Ahmedabad-based Khyati Multispeciality Hospital is under scrutiny after two PM-JAY beneficiaries died following a failed angioplasty procedure. The hospital allegedly exploited the Pradhan Mantri Jan Arogya Yojana PMJAY scheme by classifying every patient file as an emergency case, thereby fast-tracking approvals for medical procedures under the scheme.

The Crime Branch, which is investigating the case, found that the hospital exploited the PM-JAY scheme to accelerate approvals for medical procedures without properly assessing patients’ conditions. By categorizing patients as “emergency” cases, the hospital fast-tracked government approvals and subsequently claimed payments under the Central scheme.

Also read- PMJAY Fraud: Crime branch seeks Patient Records from 145 hospitals

What emerged as a shock was that the hospital used emergency tags on even patients who did not need any medical procedure, which exposed the dark side of its healthcare practices. 

In addition, the hospital allegedly bribed a few PM-JAY officers responsible for sanctioning the files which marked every patient as an emergency case. The hospital authorities knew that PM-JAY officials sanctioned between 1,300 to 4,000 emergency applications every day and therefore they exploited the process by bribing the officers.

This was revealed after the crime branch interrogated a few PM-JAY officers who admitted to the wrongdoing. According to crime branch sources, PM-JAY officials indicated that they did not take time to review each application thoroughly and relied solely on the “emergency” tag to expedite pre-authorisation requests so the hospital could proceed with the medical procedures without delay.

Speaking to TOI, a crime branch officer said, “The crime branch has already questioned a few PM-JAY officers suspected to be involved in sanctioning the claims filed by Khyati Hospital. The hospital wanted to avoid scrutiny from unfamiliar PM-JAY officers, so the hospital authorities offered bribes and marked their files as ’emergency’ to bypass the review process. This made sure they received approvals without any delay.”

Medical dialogues had earlier reported that according to the Ahmedabad crime branch, as many as 112 deaths have occurred in the past three years, either during or after treatment under government healthcare schemes. The revelation came during investigations days after the Ahmedabad crime branch arrested Dr Sanjay Patolia, a bariatric surgeon and one of the directors of city-based Khyati Multispeciality Hospital.

Between September 2021 and October 2024, nearly 8,500 patients received treatment or underwent different surgeries at the private hospital.

Meanwhile, the state health department has proposed to increase the staff from 60 to 180 personnel to handle the approval of medical reimbursement bills from hospitals. They will also demand detailed medical documents, such as angiography and angioplasty reports for heart-related procedures.

Recently, the crime branch arrested another director of the facility bringing the total number of arrests to eight. 

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