Current Women's Health Reviews - Volume 13, Issue 1, 2017

Obesity, as defined by body mass index (BMI) is one of the biggest challenges facing health care system including maternity services today, particularly in the industrialized nations. Maternal obesity is linked with a number of pregnancy complications including gestational diabetes, preeclampsia, venous thromboembolism, caesarean delivery, postpartum haemorrhage, macrosomia, shoulder dystocia and poor perinatal outcomes. Obesity has also been shown to be independently associated with higher odds of dying from specific pregnancy complications. These risks increases with increasing BMI and are highest in women with BMI ≥ 50. The mechanisms underlying these pathologies remain unclear. All obese women in reproductive age group should be counselled about weight gain, exercise programmes, nutrition and food choices, longer term health risks and increased risk of maternal and fetal complications, ideally before contemplating pregnancy. They should also be supported to lose weight and optimise their health before conception. Obese pregnant women should receive routine care supplemented by specialist services and facilities that are specific to their needs, to improve maternal and perinatal outcomes.

Obesity is a global phenomenon with unfavourable clinical and economic outcomes. The prevalence of maternal obesity has risen at similar rates to global obesity and has two distinct population pathways. Firstly, pregnancy has been identified as a risk factor for the development of obesity due to extreme gestation gain and/or prolonged postpartum weight retention. Secondly, the number of pre-gravid obese women has increased dramatically over recent years, making this a highrisk medical group. As such, effective interventions are necessary to prevent and reduce the incidence of excessive gestational weight gain and persistent postpartum weight retention, particularly in overweight and obese women. The focus of this review is on the postpartum period, which includes the first twelve months following childbirth. Exercise has many potential benefits for these women, but, despite considerable interest in the effects of physical activity on maternal body mass, few exercise-based randomised controlled trials exist. Two studies have implemented low to moderate intensity walking programmes as weight management interventions, with limited success. Two, more recent studies have used resistance exercises and active videogames to promote weight loss, however while both types of interventions resulted in significant weight loss, these reductions were not significantly different from the corresponding control groups. As such, a proof of principle with regards to exercise and weight retention in overweight and obese women is not available. More investigation is warranted in this important research area and future studies should be based on accessible, progressive, appropriate and effective exercise strategies.

The transition to menopause is associated with a myriad of physiological changes including unstable hormone levels (estrogen, progesterone) resulting in hot flashes, sleep deprivation, weight gain, mood swings and is associated with increased risk of osteoperosis and cardiometabolic disease. Exercise is a critical component of health and wellbeing at any age; however, it may be especially beneficial during and following menopause. Currently, there are no physical activity guidelines specific to post-menopausal women with obesity. However, strong evidence suggests that greater health benefits may be derived with higher levels of physical activity beyond current recommendations for adults. This review describes the potential benefits of exercise in this population, as well as reviewing current guidelines and considerations for exercise in this population.

More than one half of pregnant women are presently classified as overweight or obese and 8% of reproductive age women are extremely obese. Since 1980, obesity rates have doubled for adults and tripled for adolescents aged 12-19 years. The sturdy gains in overall health that have been achieved by Americans since the dawn of the 20th century may be perturbed by the obesogenic epidemic The aim of this review is to highlight the risks that the high-risk obese parturients encounter and discuss dietary, medical and surgical options in the care of these patients from pregestational stages until postpartum. We will review the role of diet, exercise, bariatric surgery, mode of delivery and regional or general anesthesia, where special concerns are required in the obese gravida.

Background: Engaging in physical activity (PA) and reducing sedentary behaviour (SB) are important for health during pregnancy, yet relatively few studies have examined these variables using objective measures and across trimesters during pregnancy. Objective: To determine the amount of objectively assessed PA and SB engaged in whether there was any weekday to weekend day variation in PA and SB during the first and second trimester of pregnancy. Method: PA and SB were determined using accelerometry worn over 7 consecutive days during each trimester in 137 Portuguese females (mean age ± SD = 29.6 ± 5.7). Results: In regard to the proportion of participants meeting the ACSM guidelines for PA, 37.5% of the participants in the first trimester and 29.6% of participants in the second trimester met the cut off of 30min or more of any type of moderate intensity activity on most (5) days of the week. Moderate intensity PA was significantly lower in trimester 2 compared to trimester 1 (P = 0.003). Moderate intensity PA was also significantly lower during weekends compared to weekdays irrespective of trimester (P = 0.003). SB, light and vigorous intensity PA were relatively stable from trimester 1 to trimester 2 and between weekdays and weekends (P < 0.05). Conclusion: The present study suggests that the majority of women do not meet PA guidelines for health during pregnancy and that moderate intensity PA declines form trimester 1 to 2 and is lower at weekends.

Background: One metabolic equivalent (MET) is the amount of oxygen consumed while sitting at rest and is equal to 3.5 ml O2-kg-1^-1. METs are often used to provide simple, practical, and easily understood values that reflect the energy cost of physical activity. It is plausible that the increase in body mass and absolute submaximal oxygen uptake during gestation has the potential to affect the MET of pregnant women. Objective: The aim of this study was to measure the MET during the second trimester of pregnancy and to compare this with non-pregnant women. In addition, the measured MET values were compared to those proposed by the Compendium of Physical Activities (CPA). Design: Ten pregnant and ten non-pregnant women participated in this study. Ventilatory variables and heart rate (HR) were measured during four conditions on two different days: Condition 1 - sitting, Condition 2 - lying, Condition 3 - treadmill walking and Condition 4 - cycling. The women performed two conditions on each testing day; one resting condition followed by one exercising condition. The data were analysed using a two-way ANOVA with repeated measures. Bonferroni’s tests were used when significant differences were detected. Results: The MET was not significantly different between pregnant and non-pregnant women either at rest or during exercise (p > 0.05). While cycling, the MET obtained by indirect calorimetry (IC) was significantly higher than the CPA predicted MET, regardless of group (pregnant cycling p = 0.002 and non-pregnant cycling p > 0.001). During pregnancy, ventilation and heart rate were significantly greater in both the resting and exercising conditions (p > 0.05). In general, (combined pregnant and non-pregnant data), VE and HR were significantly higher during seated rest, when compared with supine rest and all ventilatory variables, HR and ratings of perceived exertion (RPE) were significantly higher during cycling, when compared with walking (p > 0.05). Conclusion: METs were unaffected by pregnancy at rest or when undertaking either walking or cycling exercise during the second trimester of pregnancy. The MET of cycling was significantly underestimated by the CPA, when compared to IC, in both groups.

Adherence to healthy behavior and/or lifestyle modification in pregnancy including regular physical activity and judicious diet is safe and beneficial. Pregnancy is considered by most an opportune time for such interventions. Exercise in pregnancy has been universally accepted as safe and desirable. However judicious gestational weight gain guidelines for overweight and obese women are still being disputed, despite mounting evidence that with proper supervision, it is a safe and desirable intervention.

Worldwide cervical cancer is third most common cancer of all cancers in women, with 85% cases occurring in developing countries, where cervical cancer is second most frequent cause of cancer deaths in women. Global burden of cervical cancer reported for 2008 was, 529,800 cases and 275,100 deaths. It is estimated that yearly 134,420 Indian women will be diagnosed and estimated 72,825 will die with cervical cancer, because most (85%) cases present in advanced stages. In advanced cases mission of management is, shrinkage of cancer and slow its growth and spread, with minimum effects of therapy on other parts of the body. Present review is to know the possibilities of management strategies for quality survival in cases who report with advanced cervical cancer. Status: Cervical cancer that has spread locally or beyond pelvis, surgery, chemotherapy and radiotherapy can be used singly or with each other in individualized way. Treatment will depend on size, spread, number of secondaries, symptoms, cancer is causing and patient’s condition. Traditionally patients included as advanced stages are, stage IIB to IVA (locally advanced disease) and IV B, disease with metastasis at distant places. However, many, who deal with these cancers include IB2 and IIA2 disease in advanced category because these stages need multimodality therapy and outcome is poorer than early stage cases (IA through IIA1). Radiologic imaging studies are recommended for stage IB2 or greater disease for stage of cancer. MRI is useful to rule out disease high in endocervix. Histopathological confirmation is essential in all cases. Histopathology and many other things affect quality survival. Usually, advanced cervical cancer is treated with combined chemotherapy, radiotherapy (chemoradiation). In stage IVA, exenteration may be performed, by removing uterus, cervix, fallopian tubes ovaries with vagina, surrounding tissue as well as any part of bladder, bowel or rectum that is affected by cancer and create diversion of bladder, bowel or both depending upon whether anterior or posterior or complete exenteration is done. It may be not possible to do much for stage IVB cervical cancer but individualized therapy helps. Lack of needed social support, system for transport create problems including cost of therapy. In patients with refractory cancer, a comprehensive coordinated approach is needed including hospice as per need, pain specialists, emotional, spiritual support, individualized per need. Mission is survival with quality. When cure is not possible, it is essential that attempts are made to allay symptoms which affect everyday life.

Background: The cutaneous effects and suitability of a sanitary pad have been studied globally. Potassium alum has been used in menstrual pads as an antiseptic, astringent, deodorizer and antiperspirants. The aim of this study is to assess safety and suitability of a sanitary pad containing potassium alum (test) in comparison of simple pads (control) on healthy women residing in Iran. Methods: This was a phase III cross-over study design, conducted on 16 healthy women over the course of two menstrual periods. The levels of erythema, fissuring, edema and papule formation as well as burning, and itching sensations have been evaluated based on clinical observations and interviews. Measurement of pH and swabs for bacteria counting of vulvar skin were also performed. The subjects used one type of sanitary pad during their first menstrual period and then used the other type during their subsequent menstrual period. Then the evaluations were repeated and the subjects were asked to complete self-assessment questionnaires about product suitability. Results: All the volunteers (age: 18-50, mean: 37.43) completed the study. No signs of irritation were found in the clinical observations or in the interviews for either product. No significant difference from baseline was found in the number of total bacteria for either product but the vulvar areas were significantly more acidic after using product with potassium alum. The majority of subjects preferred the sanitary pad with potassium alum (p-value = 0.0416). Conclusion: Both types of sanitary pads used in this trial were same, however, the pad with Potassium alum was preferred by the participants for greater suitability.

In 2013-2014, NIHMP (the National Institute for Health, Migration and Poverty) carried out a project study in medical anthropology titled “Clinical and social evaluation of medical practices in paediatric treatment of infectious diseases for children belonging to vulnerable populations”. Using the ethnographic method, several women were interviewed on the following topics: barriers to breastfeeding; the effects of breastfeeding on the psychological and physical health of infants; the social and domestic consequences which affect those women who did not stop breastfeeding when they felt they should have. The analysis of the socio-cultural construction and its representation which emerged from these interviews was the major aim of the study. Target of the research were 46 children and adolescents emigrated to Rome, Italy, from sub-Saharan and North Africa, and from the Asian continent (Indian subcontinent, West Asia, Eurasia, Middle East and the Arabian peninsula). Some of the illnesses, including psychological and physical disorders observed in these minors, are due to those mothers who experienced traumatic events during the breastfeeding period - such as maternal Intimate Partner Violence (IPV) - thus affecting the nutritional values of their milk. This study emphasizes the importance of cultural values in infant feeding choices, defines specific barriers to breastfeeding and the effects that a mother’s choice to keep on breastfeeding or stopping it can have on both her psychological and physical health and her baby’s.