title: Parturition dysfunction in obesity: time to target the pathobiology.
abstract: Over a third of women of childbearing age in the United States are obese, and during pregnancy they are at increased risk for delayed labor onset and slow labor progress that often results in unplanned cesarean delivery. The biology behind this dysfunctional parturition is not well understood. Studies of obesity-induced changes in parturition physiology may facilitate approaches to optimize labor in obese women. In this review, we summarize known and proposed biologic effects of obesity on labor preparation, contraction/synchronization, and endurance, drawing on both clinical observation and experimental data. We present evidence from human and animal studies of interactions between obesity and parturition signaling in all elements of the birth process, including: delayed cervical ripening, prostaglandin insensitivity, amniotic membrane strengthening, decreased myometrial oxytocin receptor expression, decreased myocyte action potential initiation and contractility, decreased myocyte gap junction formation, and impaired myocyte neutralization of reactive oxygen species. We found convincing clinical data on the effect of obesity on labor initiation and successful delivery, but few studies on the underlying pathobiology. We suggest research opportunities and therapeutic interventions based on plausible biologic mechanisms.
authors.affiliation: Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road NE, Atlanta, GA, 30322, USA. Nicole.Carlson@emory.edu.
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Carlson
authors.affiliation: Department of Medicine, Division of Endocrinology, Metabolism, & Diabetes, College of Nursing, University of Colorado School of Medicine, 12801 E. 17th Ave, MS 8106, Aurora, CO, 80045, USA. Teri.Hernandez@ucdenver.edu.
authors.forename: Teri L
authors.initials: TL
authors.lastname: Hernandez
authors.affiliation: Department of Obstetrics & Gynecology, Divisions of Maternal-Fetal Medicine & Reproductive Sciences, University of Colorado School of Medicine, 12700 East 19th Ave, MS 8613, Aurora, CO, 80045, USA. K.Joseph.Hurt@ucdenver.edu.
authors.forename: K Joseph
authors.initials: KJ
authors.lastname: Hurt
mesh_terms: D054392:Adipokines / Q000502:physiology; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data; D002784:Cholesterol / Q000502:physiology; D004420:Dystocia / Q000453:epidemiology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000453:epidemiology; D020738:Leptin / Q000097:blood; D009215:Myometrium / Q000503:physiopathology; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D036801:Parturition / Q000502:physiology*; D010641:Phenotype; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011453:Prostaglandins / Q000502:physiology; D018045:Receptors, Oxytocin / Q000502:physiology; D015398:Signal Transduction; D014590:Uterine Contraction / Q000502:physiology; D014599:Uterus / Q000503:physiopathology
chemical_list: D054392:Adipokines; D020738:Leptin; D011453:Prostaglandins; D018045:Receptors, Oxytocin; D002784:Cholesterol