Papers by Elisabetta Petrella
American Journal of Obstetrics and Gynecology
Minerva obstetrics and gynecology, Apr 1, 2022
BACKGROUND Obesity is a widespread pandemic and obstetric care must adapt to meet the needs of ob... more BACKGROUND Obesity is a widespread pandemic and obstetric care must adapt to meet the needs of obese pregnant women. Little is known about the impact of body mass index (BMI) on the induction of labor (IOL). Therefore, our objective was to evaluate if the duration of the first and second stages of IOL is affected by maternal BMI in nulliparous and multiparous women. METHODS We included singleton pregnancies at term with cephalic presentation whose labor was induced from June 2018 to December 2019. Women were divided into two groups according to pre-pregnancy BMI in Normal Weight and Obese Women. RESULTS A total of 668 women with IOL were included in the study, among them, 349 had a normal weight and 321 were obese. The first stage of labor was longer in obese multiparous than normal-weight women (normal weight 81.98 ± 71.7 vs obese 134.3 ± 158.1 (min), p=0.000), while the second stage resulted significantly shorter (normal weight 22.2 ± 27.8 vs obese 14.3 ± 14.2 (min), p=0.000). The total time elapsed from IOL beginning and delivery was significantly higher in obese nulliparous (normal weight 10.4 ± 19.7 vs obese 22.0 ± 26.2 (h), p=0.000). Operative vaginal deliveries, emergency cesarean section, and failed IOL resulted to be similar between the groups. CONCLUSIONS Obese multiparous women have longer first stages of labor while shorter second stages. The total time for induced obese nulliparous to reach delivery is higher than the normal weight. It might be reasonable to reconsider the partographs according to maternal BMI in case of induced labor for future obstetric practice.
The British Journal of Radiology, 2020
Objective: To assess accuracy and reproducibility of MRI diagnosis of invasive placentation (IP) ... more Objective: To assess accuracy and reproducibility of MRI diagnosis of invasive placentation (IP) in high-risk patients and to evaluate reliability of MRI features. Secondary aim was to evaluate impact of interventional radiology (IR) on delivery outcomes in patients with IP at MRI. Methods: 26 patients (mean age 36.24 y/o,SD 6.16) with clinical risk-factors and echographic suspicion of IP underwent 1.5 T-MRI. Two readers reviewed images. Gold-standard was histology in hysterectomised patients and obstetric evaluation at delivery for patients with preserved uterus. Accuracy and reproducibility of MRI findings were calculated. Results: Incidence of IP was 50% (13/26) and of PP was 11.54% (3/26). MRI showed 100% sensitivity (95% CI = 75.3–100%) and 92.3% specificity (95% CI = 64.0–100%) in the diagnosis of IP. Gold-standard was histology in 10 cases and obstetric evaluation in 16. MRI findings with higher sensitivity were placental heterogeneity, uterine bulging and black intraplacenta...
American Journal of Obstetrics and Gynecology, 2019
The Journal of Maternal-Fetal & Neonatal Medicine, 2013
Objectives: To determine whether changes in lifestyle in women with BMI425 could decrease gestati... more Objectives: To determine whether changes in lifestyle in women with BMI425 could decrease gestational weight gain and unfavorable pregnancy outcomes. Methods: Women with BMI425 were randomized at 1st trimester to no intervention or a Therapeutic Lifestyle Changes (TLC) Program including diet (overweight: 1700 kcal/day, obese: 1800 kcal/day) and mild physical activity (30 min/day, 3 times/week). At baseline and at the 36th week women filled-in a Food Frequency Questionnaire. Outcomes: gestational weight gain, gestational diabetes mellitus, gestational hypertension, preterm delivery. Data stratified by BMI categories. Results: Socio-demographic features were similar between groups (TLC: 33 cases, Controls: 28 cases). At term, gestational weight gain in obese women randomized to TLC group was lower (6.7 AE 4.3 kg) versus controls (10.1 AE 5.6 kg, p ¼ 0.047). Gestational diabetes mellitus, gestational hypertension and preterm delivery were also significantly lower. TLC was an independent factor in preventing gestational weight gain, gestational diabetes mellitus, gestational hypertension. Significant changes in eating habits occurred in the TLC group, which increased the number of snacks, the intake of fruits-vegetables and decreased the consumption of sugar. Conclusions: A caloric restriction associated to changes in eating behavior and constant physical activity, is able to reduce gestational weight gain and related pregnancy complications in obese women.
Esistono varie evidenze che sembrano legare folati ed osteoporosi. I folati sono una serie di com... more Esistono varie evidenze che sembrano legare folati ed osteoporosi. I folati sono una serie di composti vitaminici del gruppo della vitamina B che sono necessari quali donatori di metile per la trasformazione dell’omocisteina in metionina. Studi osservazionali hanno evidenziato che individui con deficit genetici nel metabolismo dell’omocisteina hanno un maggior rischio di sviluppare osteoporosi e frattura. Ugualmente studi osservazionali hanno evidenziato che elevati livelli di omocisteina si associano ad un maggior rischio di frattura. La presenza di folati e necessaria per la riduzione dei livelli di omocisteina. Gli studi che hanno considerato oltre che i livelli di omocisteina anche i livelli di folati hanno evidenziato come i bassi livelli di folati rappresentino un fattore di rischio maggiore rispetto ai livelli di omocisteina per bassi valori di massa ossea, per la velocita di perdita di massa ossea e per fratture osteoporotiche. I folati sembrano pertanto agire nella prevenzi...
Pregnancy Hypertension, 2021
Objective: To evaluate the L-arginine/NO system and its role in insulin signaling and endothelial... more Objective: To evaluate the L-arginine/NO system and its role in insulin signaling and endothelial function during the pregnancy of women of different BMI categories. Study design: Twelve women with BMI P 25 were compared with 10 normal-weight women in a fasting condition after the infusion of L-arginine (20 g in 3 h) and after the evaluation of the flow-mediated vasodilation (FMD) of the brachial artery between the 9th-12th and 24th-27th weeks. Blood samples for insulin and nitrite/nitrate (NOx) were collected at baseline and after 1, 2 and 3 h after initiating the infusion. Results: In both trimesters, the baseline NOx levels were similar among groups. In the 1st trimester of the lean women, there was a NOx increase in response to L-Arg (AUC: 1328; 3, 3173), which had increased by the 2nd trimester (AUC: 3884; 1905, 7686); in overweight/ obese women, no responses to L-Arg were found in the 1st or 2nd trimesters. In the 1st trimester, the insulin levels were significantly reduced in both groups after L-Arg infusion. Although the insulin levels in all BMI categories were higher in the 2nd trimester, such levels during weeks 24-27 were suppressed only in normal-weight women after L-Arg infusion. The FMD was higher during both trimesters in the lean controls and was impaired in the overweight/obese subjects. Conclusions: NO availability is impaired in overweight/obese women during pregnancy, which affects endothelial functioning and interferes with insulin regulation. These mechanisms could be involved in the development of hypertensive disorders and glucose intolerance in this population.
I livelli di follati pi\uf9 che quelli di omocisteina sonno correlati in maniera diretta alla den... more I livelli di follati pi\uf9 che quelli di omocisteina sonno correlati in maniera diretta alla densit\ue0 minerale ossea delle vertebre lombari di donne in postmenopaus
Introduction: Obesity and excessive gestational weight gain (GWG) have been associated with highe... more Introduction: Obesity and excessive gestational weight gain (GWG) have been associated with higher occurrence of large for gestational age (LGA) babies, and several interventions have been proposed to limit GWG, which, however, does not reflect adequately the subtle changes in body composition that happens during pregnancy. The aim of this study is to evaluate if the variations of body composition, induced by a lifestyle program intended to limit GWG and measured through bioelectrical impedence analysis (BIA), could affect the newborns’ weight in overweight/obese women. Methods: One hundred and thirty-nine women with BMI ≥ 25 kg/m 2 were enrolled between 9 th -12 th week and a lifestyle program, consisting of low glycemic diet with caloric restriction and physical activity, was prescribed to them. BIA was performed at enrolment and at 35 th -36 th week. Data regarding the newborns’ weight were collected from clinical charts after delivery. Results: Women who exceeded recommended ran...
The Journal of Maternal-Fetal & Neonatal Medicine, 2021
OBJECTIVE Obesity is one of the main risk factors for the development gestational diabetes mellit... more OBJECTIVE Obesity is one of the main risk factors for the development gestational diabetes mellitus (GDM). Thus, we aim to identify changes in the urinary metabolomics profile of obese women at first trimester of pregnancy in order to predict later GDM diagnosis. RESEARCH DESIGN AND METHODS In this nested case-control study, urine samples collected in the first trimester of pregnancy obtained from obese women who developed GDM (n = 29) and obese women who did not develop diabetes (n = 25 NO GDM) were analyzed with Nuclear Magnetic Resonance spectroscopy combined with Multivariate Statistical Analysis. GDM diagnosis was obtained with one-step oral glucose load. RESULTS OPLS-DA significantly separated the GDM women from NO GDM women. Specifically, GDM women were characterized by a higher level of tryptophan, trigonelline, hippurate, and threonine, and lower levels of 1-methylnicotinamide, 3-hydroxykynurenine, glycocholate, isoleucine, kynurenine, and valine compared to NO GDM women. CONCLUSION In a prevalently Caucasian population, the changes of some metabolites such as tryptophan, trigonelline, and branch-chained amino acids in the urinary profile of obese women in the first trimester are able to make unequivocal prediction of those which later test positive for GDM. This approach could be useful to diagnose much earlier obese women with GDM allowing lifestyle counselling and other interventions.
Minerva Obstetrics and Gynecology, 2018
BACKGROUND To determine whether the prescription and follow-up of a behavioral program (customize... more BACKGROUND To determine whether the prescription and follow-up of a behavioral program (customized nutritional advices and a constant physical activity) influences the occurrence of unfavorable maternal/neonatal outcomes among overweight/obese women. METHODS A case-control study (1:3) included single pregnant women with Body Mass Index (BMI) ≥25 kg/m2, enrolled at 1st trimester. Cases (N.=95) were prescribed (by both the dietitian and gynecologist) a low-glycemic-index diet with an average intake of 1700/1800 kcal/day plus 30 minutes of walking at least 3 times/week (with four follow-up visits until delivery). Controls (N.=275) received a nutritional booklet about a healthy lifestyle, then attended their scheduled visits until delivery by the obstetricians in charge. RESULTS Gestational weight gain was similar between groups, despite obese women were higher in cases (67.4%) than in controls (54.5%, P=0.029). The occurrence of gestational diabetes mellitus (GDM) was lower in cases (21.5%) than in controls (32.7%; P=0.041). Such reduction remained related with the group of intervention (P=0.004) after correcting for confounders (BMI≥30 kg/m2, a family history of diabetes, age ≥35 and ethnicity). A higher number of controls developed pregnancy induced hypertension (PIH) (11.6% vs. 1.1% in cases, P<0.001). Preterm birth (PTB) occurred in one case and in 28 controls (10.2%; P=0.004). In half of them, PTB was spontaneous while medically indicated for intrauterine growth restriction, hemorrhage, PIH, GDM/macrosomia, Rh isoimmunization in the remnant. CONCLUSIONS An early behavioral intervention among overweight/obese pregnant women reduces unfavorable pregnancy outcomes.
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Papers by Elisabetta Petrella