Dr Kabukoba’s work has been covered extensively
He has appeared in national media including
The Times, Daily Express and The Daily Telegraph newspapers; on SKY News television and on BBC radio in relation to the innovative work that he has undertaken.
Monthly Archives: February 2012
Pregnancy Complications Predict Future Heart Disease
Pregnancy Complications
Pregnancy Complications Predict Future Heart Disease
And most pregnancy complications are associated with pregnancy obesity
A recent study published from the UK by Fraser and others, as a result of European data has demonstrated that pregnancy provides opportunities to identify women at risk of future heart related problems such as heart attacks.
The study monitored what happened to women who had pregnancy problems, such as pregnancy obesity, high blood pressure, pregnancy convulsions and pregnancy related diabetes.
The findings provide yet another way for doctors and health care workers advising women who are at risk and monitoring them for complicattions.
The problem is not all doctors have access to pregnancy related problems, within the context of monitoring for future cardiovascular problems.
For example, pregnant obese women who develop pregnancy related diabetes and have long been known to be at risk of diabetes in pregnancy are only monitored for 6 months after pregnancy.
To read more about read these findings see the full abstract here:
Associations of Pregnancy Complications with Calculated CVD Risk and Cardiovascular Risk Factors in Middle Age: The Avon Longitudinal Study of Parents and Children
Background—The nature and contribution of different pregnancy related complications to future cardiovascular disease (CVD) and its risk factors, as well as mechanisms underlying these associations remain unclear.
Methods and Results—We studied associations of pregnancy diabetes, hypertensive disorders of pregnancy (HDP), preterm delivery and size for gestational age with calculated 10 year CVD risk
(based on the Framingham score) and a wide range of cardiovascular risk factors measured 18 years after pregnancy (mean age at outcome assessment: 48 years) in a prospective cohort of 3,416 women.
Conclusions—HDP and pregnancy diabetes are independently associated with an increased calculated 10 year CVD risk.
Our results suggest that pregnancy may be an important opportunity for early identification of women at increased risk of CVD later in life.
The findings of this study confirm what has been known and some have been suspected. For example that women who are obese before pregnancy are likely to gain more pregnancy weight than women who are normal weight.
It is also known that women who are obese are at higher risk of hypertension in pregnancy, pregnancy related convulsions known as Eclampsia. Furthmore, it is known that women who are obese through pregnancy are likely to be obese after pregnancy.
This is the same group of women at risk of future heart related problems.
The take home message for you and me is to lose weight before pregnancy, remain active during pregnancy, lose the weight after pregnancy and get fit.
It is not always easy to lose pregnancy weight after pregnancy, but as has been reported recently, simple exercises such as walking does a lot of good.
pregnancy complications, pregnancy obesity, weight loss after pregnancy, heart disease, hypertension in pregnancy,
Pregnancy Complications
Physical Activity, Diet and Pregnancy weight gain among Latinas
Pregnancy Weight Gain
Physical Activity, Diet and Pregnancy weight gain among Latinas
Pregnancy exercises
This article adds deeper understanding of the causes of excessive pregnancy weight gain among Latinas in United States.
It is now well established that pre-pregnancy obesity influences pregnancy weight gain. Obesity before pregnancy is influenced by social, culture, economic and other yet to be determined factors.
This study focused on factors that influence pregnancy weight gain in a section of the United States population that is generally regarded as inadequately studies, provided for and supported when it comes to obesity in pregnancy.
The full paper by Chasan-Taber L is published in the Journal of Nutrition. The abstract is available here.
excerpt:
Physical activity and dietary behaviors associated with weight gain and impaired glucose tolerance among pregnant latinas.
Chasan-Taber L.Pregnancy has been proposed as a critical period for the development of subsequent maternal overweight and/or obesity.
Excessive gestational weight gain is, in turn, associated with maternal complications such as cesarean delivery, hypertension, preeclampsia, impaired glucose tolerance, and gestational diabetes mellitus.
Latinos are the largest minority group in the United States, with the highest birth and immigration rates of any minority group and are disproportionately affected by overweight and obesity.
However, due to cultural factors, socioeconomic factors, and language barriers, Latinos have had limited access to public health interventions that promote healthy lifestyles.
A second objective is to discuss how lifestyle interventions including weight management through diet and exercise could be successful in reducing the risk of excessive gestational weight gain and gestational diabetes mellitus.
Finally, recommendations are provided for future lifestyle intervention programs in this population with a focus on translation and dissemination of research findings.
More than usual pregnancy weight gainleads to complications includin high blood pressure, diabetes of pregnancy, large babies and poor pregnancy outcomes.
This study provides outline of what can be done to improve the social and lifestyle experiences of latinas. Lesson identified here of course apply universally…almost.
pregnancy weight gain, pregnany weight, weight loss after pregnancy, exercise during pregnancy, pregnancy diet,
Pregnancy Weight Gain
Post Pregnancy Obesity Worse With High Male Hormones
Weight Loss After Pregnancy
Your Male Hormones May Be Making Weight Loss After Pregnancy Harder
Try to understand the mechanism of obesity so you can shed more successfully the weight after pregnancy.
This summary of an article in Maturitas will help you along.
Men and women do share some hormones, as you know. The male hormone in women, the androgen testosterone, is thought to contribute to obesity in women, particularly central obesity.
You will also be aware that there are different types of obesity, commonly referred to as the pear-type and apple-type.
The pear type is obesity aroung the hips with a smaller waist, leaving the feminine figure of
the woman almost intact. The apple type obesity is the reverse, where the fat is about the
abdomen, making the hips smaller than the tummy.
It is thought the apple type obesity, where fat is concentrated in the belly, is the one influenced by the male horomone.
Some women exhibit more male features than other women depending on their constitutional predisposition. You will have also noticed that heavier women have a higher risk of excessive hair both on the chin and lips. This is called hirsuitism.
Furthermore, older women fatter women have more facial and chin hair than younger and leaner women.
These features in younger women are due to higher female type hormones, the estrogens, than older women. It is important that you realize that younger women’s ratio of estrogen to testosterone is much higher than that in older women.
This explains the reasons why older fatter women have such terrible problems comparable to men’s in terms of heart disease, diabetes and also have increased risks for cancer of the womb.
This article by Hirschberg, A L is therefore very important to women who are young and obese in many ways, particularly that once obese they are almost set up to gain more weight unless they intentionally and actively act to overcome that disadvantage.
To read this abstract please follow this link:
Excerpt:
Sex hormones, appetite and eating behaviour in women
Sex hormones play essential roles in the regulation of appetite, eating behaviour and energy metabolism and have been implicated in several major clinical disorders in women.
Estrogen inhibits food intake, whereas progesterone and testosterone may stimulate appetite.
This review describes recent findings concerning interactions between sex hormones and
neuroendocrinological mechanisms in the control of appetite and eating in women.Furthermore, we are gaining insights into the roles played by sex hormones in the development of eating disorders and obesity.
Androgens are also involved in the pathophysiology of abdominal obesity in women.
In conclusion, sex hormones and/or agents that exhibit similar activities may provide novel strategies for the treatment of eating disorders and android obesity, two of the most serious health problems for women today.
Women at any stage even after childbirth are at risk. Increased male hormones increase your appetite and behaviour that are conducive to gaining weight.
Women with polycystic disease are the most risk because they have higher male type hormone, testosterone.
Women who are overweight or have not managed to lose weight after pregnancy, are at risk like any other woman. The take home message is that losing weight after pregnancy long term could be eased now you know the underlying mechanisms that make the job a little bit harder.
pregnancy weight, after pregnancy weight, pregnancy weight loss, after pregnancy, weight loss, Appetite, Eating disorders, Obesity, Weight, Women’s health,
Weight Loss After Pregnancy
Obesity In Pregnancy And Diabetes – Everyone Beware
Obesity In Pregnancy
Obesity In Pregnancy Predisposes to Pregnancy Related Diabetes
In the prevailing situation with high prevalence pregnancy obesity rates, this study is timely reminder of the risks. 
In this paper, Drs Gabbe and others, discuss the importance of increased awareness and testing for Gestational Diabetes Mellitus, the type of diabetes seen in pregnancy.
Obesity and particularly obesity in pregnancy is on the increase, worldwide. It is estimated that up to 30% of pregnant women are obese.
Therefore the risk and prevalence of Diabetes is high among the pregnant population.
The complications of diabetes in pregnancy affects both mother and baby; with the offspring facing higher risks of childhood obesity and diabetes themselves.
See the complete abstract here:
Excerpts:
Promoting Health After Gestational Diabetes: A National Diabetes Education Program Call to Action
Gabbe, Steven G. MD; Landon, Mark B. MD; Warren-Boulton, Elizabeth RN, MSN; Fradkin, Judith MD
Up to one third of GDM (gestational Diabetes Mellitus) women may have diabetes or prediabetes postpartum, yet only about half of these women are tested postpartum, and about a quarter are tested 6–12 weeks postpartum.
Women with GDM face a lifelong increased risk for subsequent diabetes, primarily type 2 diabetes mellitus.
The American College of Obstetricians & Gynecologists and the American Diabetes Association recommend testing women with a history of GDM at 6–12 weeks postpartum. If the postpartum test is normal, retest every 3 years and at the first prenatal visit in a subsequent pregnancy.
Because children of GDM pregnancies face an increased risk for obesity and type 2 diabetes mellitus, families need support to develop healthy eating and physical activity behaviors.
Current criteria indicate that GDM occurs in 2% to 10% of all pregnancies.
The projected increase in the number of women with GDM and the potential subsequent associated risks underscore the need for proactive long-term primary care treatment of the mother and her children.
The message of the paper is to both the professionals and the pregnant women. It urges the obstetrician to test and counsel pregnant women appropriately. It is also a timely message to women and particularly pregnant women to be aware of the risk of pregnancy obesity, and to adopt lifestyle changes that will lead to reduced risks to themselves and their children.
Obesity In Pregnancy
Weight Loss After Pregnancy – Walking Does It
Weight Loss After Pregnancy
Abundant Evidence – Walking Works Wonders for Your Weight Loss After Pregnancy
Walking Does It - After Baby
This is a well designed study bearing an important message for weight loss after pregnancy.
It is a study of women following childbirth, aimed at measuring the impact of walking on the women’s ability to lose pregnancy weight.
A small group of women were divided into two groups one encourage to progressively increase their working program to 10,000 steps by 12 weeks and other was left to their own devices.
At the end of the study period, the group of women who were encouraged to walk and keep a record by a pedometer had lost a lot more weight, were more active than the control group.
To read the full article go here:
excerpt:Effect of physical activity intervention based on a pedometer on physical activity level and
anthropometric measures after childbirth: a randomized controlled trial.
S Maturi M, Afshary P, Abedi P.Pregnancy and childbirth are associated with weight gain in women, and retention of weight gained during pregnancy can lead to obesity in later life.
Diet and physical activity are factors that can influence the loss of retained pregnancy weight after birth. Exercise guidelines exist for pregnancy, but recommendations for exercise after childbirth are virtually nonexistent.
The aim of this study was to evaluate the effect of physical activity intervention based on
pedometer on physical activity level and anthropometric measures of women after childbirth.
METHODS:We conducted a randomized controlled trial in which 66 women who had given birth 6 weeks to 6 months prior were randomly assigned to receive either a 12 week tailored program encouraging increased walking using a pedometer (intervention group, n=32) or routine postpartum care (control group, n=34).
During the 12-week study period, each woman in the intervention group wore a pedometer and recorded her daily step count. The women were advised to increase their steps by 500 per week until they achieved the first target of 5000 steps per day and then continued to increase it to minimum of 10,000 steps per day by the end of 12th week.
After 12 weeks, women in the intervention group had significantly increased their physical activity and energy expenditure per week (4394 vs. 1651 calorie, p < 0.001). Significant
differences between-group in weight (P=0.001), Body Mass Index (P=0.001), waist circumference (P=0.001), hip circumference (P=0.032) and waist-hip ratio (P=0.02) were presented after the intervention.The intervention group significantly increased their mean daily step count over the study period (from 3249 before, to 9960 after the intervention, p < 0.001).
This elegantly designed study has several key messages
1. Simple things work towards losing weight after pregnancy
2. Encouragement to increase physical activity as soon after pregnancy is important
3. Those who walk can lose a lot of weight in a relatively short period of time.
4. Recording activity is key.
This study demonstrates and supports previous studies that have shown than walking walks and also that support and encouragement does lead to increased activity and weight loss after pregnancy.
Weight Loss After Pregnancy
Obesity Surgery Leads To Better Pregnancy Outcomes
Surgery reduces Pregnancy Obesity and Leads To Improved Outcomes
Pregnancy obesity, and indeed outside pregnancy, is on the rise. One of the successive treatment methods for morbidity obesity is surgery. A lot of studies have shown conclusively the effectiveness of bariatric surgery in the treatment of severe obesity.
Grossly obese women have serious risks before, during pregnancy and after childbirth. Therefore studies have been accumulating evidence to see how obesity surgery affects pregnancy and pregnancy outcomes.
In the paper published by Daltra M G, Chilelli N C and Lapolla A, published recently show that bariatric obesity surgery is followed by significant advantages, including reduced the incidence of obesity in offsprings of mothers who have had surgery.
To read more about the this study go to the abstract here:
excerpt:
Pregnancy and foetal outcome after bariatric surgery: A review of recent studies.
Dalfrà MG, Busetto L, Chilelli NC, Lapolla A.Abstract It is well known that maternal obesity has adverse effects on the health of offspring, causing immediate and long-term morbidities. The various types of procedure coming under the heading of bariatric surgery have proved effective in preventing some maternal and foetal complications in morbidly obese pregnant women.
This review aims to assess the role, the risks, and the benefits of bariatric surgery for mothers and offspring.
According to recent findings, pregnancy and neonatal outcomes in morbidly obese women who have undergone bariatric surgery depend to some extent on the type of surgery used.
Maternal complications, nutritional defects, and intestinal obstruction are more frequently reported after Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) than after laparoscopic adjustable gastric banding (LAGB) procedures, whereas caesarean section, pre-term delivery, and neonatal death are more commonly reported after RYGB than after LAGB.
Data on pregnancy and bariatric surgery confirm that the procedure is more effective than dietary measures alone in morbidly obese women, and that pregnancy outcome is generally favourable after surgery.
Some studies have indicated, nonetheless, that pregnancies after bariatric surgery are at higher risk: the women affected require special medical attention, particularly as concerns gastrointestinal symptoms and vitamin deficiencies, warranting nutritional/dietary counselling by a multidisciplinary team before, during, and after pregnancy.
Obesity surgery is more effective in treating obesity than non-surgical methods of lifestyle and behavioural changes for those people who are grossly overweight.
Surgery limits the amount of food that can be eaten. It is therefore not hard to see how surgery works by limiting the calorie intake for the individual who otherwise has found it difficult.
However, not all types of obesity surgery are equally effective and have differing risk and complications profile.
These kinds of obesity treatments methods cannot be a realist possibility for the vast majority of women.
As experience and evidence is gathered, bariatric surgery will be more readily available for many more people thus limiting complications of pregnancy obesity.
pregnancy obesity, obesity in pregnancy, obesity surgery, pregnancy outcomes
Posted in Blog, New In The News
Tagged Obesity in Pregnancy, obesity surgery, pregnancy obesity, pregnancy outcomes, pregnancy weight
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Pregnancy Nutrition Determines Risk of Future Childhood Obesity in Offspring.
Poor pregnancy nutrition is highly associated with lifelong problems in the child
Given current trends of obesity both of children and adults, a lot of effort is going into
understanding causes, factors and treatments of obesity, particularly how pregnancy nutrition and fetal growth influence future events. 
The latest study by FukamiT and others, published in the Journal Reproductin Science has discovered that restriction of growth of babies in the womb, set them up for obesity in their childhood and adulthood.
They found that babies who have been starved in the womb, and therefore had poor growth, had brains programmed to eat more and respond less readily to feeding. This meant they ate more than their counter parts.
This finding confirms a lot of what has been known already, namely that factors in the womb, have lifelong implications.
There are numerous studies have confirmed the important of adequate pregnancy nutrition and the consequences of poor or insufficient maternal nutrition on health outcomes of adults malnourished in the womb. These individuals tend to grow to be obese adults with higher risks of diseases such as obesity and heart disease.
What does this mean to women? This means there is lot you can do to influence the course of events in pregnancy and for the rest of the life of your unborn baby.
To read the original article abstract go here:
Excerpt
Mechanism of Programmed Obesity in Intrauterine Fetal Growth Restricted Offspring: Paradoxically
Enhanced Appetite Stimulation in fed and Fasting States.
We have shown that intrauterine fetal growth restriction (IUGR) newborn rats exhibit hyperphagia, reduced satiety, and adult obesity. Adenosine monophosphate (AMP)-activated protein
kinase (AMPK) is a principal metabolic regulator that specifically regulates appetite in the
hypothalamic arcuate nucleus (ARC).We hypothesized that IUGR offspring would exhibit upregulated hypothalamic AMPK, contributing to hyperphagia and obesity. We determined AMPK activity and appetite-modulating peptides (NPY and POMC) during fasting and fed conditions in the ARC of adult IUGR and control females.
In the fed state, IUGR adult females demonstrated evidence of persistent appetite stimulation with significantly upregulated phospho (Thr(172))-AMPKα/AMPK (1.3-fold), NPY/AgRP (2.3/1.8-fold) and decreased pAkt/Akt (0.6-fold) and POMC (0.7-fold) as compared to fed controls.
Despite obesity, fed IUGR adult females exhibit upregulated AMPK activity and appetite
stimulatory factors, similar to that exhibited by fasting controls.These results suggest that an enhanced appetite drive in both fed and fasting states contributes to hyperphagia and obesity in IUGR offspring.
Of course it is legitimate to ask a scientific and social question as to how relevant these
study findings are to the human experience.
You will be aware, studying animals shed light in what happens in humans. The study of rats mimic what goes in humans in most cases, and this study confirms what has been known to happen in humans who have been poorly grown in the womb.
The results in this study are in keeping with other studies. It provides the details biological
explanation, in terms of enzymatic process that are taking place in the brain to produce the results we have seen in communities and other studies.
The problem is whether there is very much one can do to prevent poor growth of the baby in the womb. Common causes of intra-uterine restricted growth include smoking, obesity, blood pressure problems, diabetes and poor pregnancy nutrition.
pregnancy obesity, pregnancy nutrition, poor pregnancy nutrition, intrauterine growth retardation, childhood obesity
Healthy Nutrition – For Lower Miscarriage Risk and Pregnancy Obesity
Pregnancy Obesity, Miscarriages and Poor Nutrition Are Strongly Linked
It is widely known in scientific circles that pregnancy obesityand miscarriages are linked and are extremely common and distressing. Another cause of stress and frustration is that investigations into the causes of miscarriages are not usually helpful in identifying the cause.
Frustration of Miscarriage
Reassuringly, even after a miscarriage, the chance of a successful pregnancy afterwards is high in the region of 60-75%.
However, it is estimated that about 1% of pregnant women experience recurrent miscarriages, for unknown reasons. Immunological, chromosomal and metabolic causes are usually suspected to be responsible for the majority of these events.
It is also known that women who are obese face increased risks of failure to conceive, and when they do, have a higher risk of miscarriages.
A recent review of scientific literature has concluded and emphasized the need for healthy nutrition in a bid to improve risk of miscarriage and pregnancy obesity.
excerpt:
Miscarriage concerns approximately 15% of pregnancies and recurrent fetal loss (RFL) constitute a particular situation concerning approximately 1% of women.
Nutritional factors represent a promising aspect, insufficiently investigated even if numerous studies underline their impact on fertility, gametogenesis, embryonic development and pregnancies outcome.
Obesity is considered as an independent risk factor for miscarriage, involved in oocyte and embryo quality, but also in endometrial receptivity. The male part involved in miscarriage was for a long time underestimated, neglecting the role of sperm in embryo development.
It is particularly important to take into account nutritional factors as favoring miscarriage because they represent a flexible factor on which intervention is possible to improve pregnancy outcome, with toxics eviction and recommendations for diversified and well-balanced food. At last, effects of nutritional complements for miscarriage prevention remain controversial.
It is therefore advisable for women to manage their weight before pregnancy to reduce the risk of miscarriage and also other problems related to pregnancy obesity.
Another strategic consideration is to consider losing weight after pregnancy, in preparation for the next one even if it seems to be far away in the future!
Healthy nutrition, pregnancy miscarriage, pregnancy obesity, pregnancy weight
Excessive Maternal Pregnancy Weight Gain Increases Diabetes Risk.
Excessive Pregnancy Weight
Gaining Excessive Pregnancy Weight Is Risky
A recent publication in the prestigious Obstetrics & Gynecology journal, March 2012, shows that women who experience excessive pregnancy weight face a higher risk of pregnancy induced Diabetes Mellitus.
The reason this study is important is that women and healthcare professionals can keep a watchful eye on women who are seen to be gaining more pregnancy weight than expected.
The original article is here:
OBJECTIVE: To assess maternal weight gain before 24 weeks in women developing gestational diabetes mellitus (GDM) compared with controls with normal glucose tolerance.
This was a retrospective cohort study of maternal weight gain. Women developing GDM were matched to three controls by self-reported prepregnancy body mass index (BMI), maternal age, race, and parity. Women without documented pregravid or 22- to 24-week weights and multiple gestations were excluded. The primary outcome was weight gain through 24 weeks of gestation.CONCLUSION: Women who develop GDM have higher gestational weight gain through 24 weeks. Gestational weight gain is a significant risk factor for GDM in the overweight or obese patient but not in patients who were underweight or had a normal BMI before pregnancy.
Every pregnant woman is expected to gain weight. It is an essential and beneficial adaptational change that is supportive to the woman and baby. However pregnancy weight gain can be excessive in women who are predisposed to diabetes.
The placenta, or afterbirth, produces several hormones whose function is to alter the pregnant mom’s metabolism in way that builds reserve and provides food for the baby. This set up was critical in times of scarse food centuries gone by.In some women this process can “go too far” and lead to impaired metabolism of carbohydrates and diabetes.
Although pregnancy weight gain natural, excessive weight gain is associated with among other things, Diabetes mellitus, professionally known as Gestational Diabetes Mellitus (GDM).
The take home message here is that women gaining excessive pregnancy weight should be carefully monitored and tested by their obstetricians to exclude pregnancy induced diabetes.
This study comes at the same time that points to reduced risks of pregnancy induced diabetes in obese women who underwent stomach (bariatric) surgery to treat their obesity.
The best strategy is to be of normal weight before pregnancy because women who start conceive being overweight are known to gain more pregnancy weight than those of normal weight.
pregnancy weight, pregnancy induced diabetes, excessive pregnancy weight
Excessive Pregnancy Weight
Lower Pregnancy Weight Leads To Lower Pregnancy Diabetes Risk
Lower pregnancy weight after surgery is again confirmed to be associated with lower risk of diabetes in pregnancy.
A recent study published in Obstetrics & Gynecology, March 2012, (The Green Journal), has confirmed that surgery to treat obesity or morbid obesity before pregnancy is associated with a lower risk of developing Diabetes during pregnancy.
This is excellent news. Earlier studies had already reported similar findings, but this latest study has larger numbers, that means the conclusions are more reliable.
To read more about this article, you can access it here:
To estimate the rates of pregnancy outcomes of women after bariatric surgery relative to women in a control groups.
Prepregnancy obesity has become an increasing problem among women of reproductive age.1,2 A recent study examining the prevalence of prepregnancy obesity in nine states found that its prevalence increased a total of 69.3% in the decade of analysis, from 13% in 1993–1994 to 22.0% in 2002–2003.3 Women are not only beginning pregnancy at a higher body mass index (BMI, calculated as weight (kg)/[height (m)]2) but also they are also gaining more than has been recommended by the Institute of Medicine, and they are more likely to retain this excess weight after delivery.4–7
Obesity has been associated with multiple medical and reproductive health problems, including increased rates of gestational diabetes and preeclampsia.8–11 Children born to obese mother are also at risk, with higher rates of fetal growth restriction, macrosomia, stillbirth, and childhood obesity.11,12
There was a significant decrease in rate of gestational diabetes in bariatric surgery patients (0.0%) as compared with both control groups
What is the importance of this study?
It is the fact that lower weight pregnancy weight is associated with lower risk of diabetes. The study involved women who became pregnant after surgery for obesity. These patients were very heavy before pregnancy, and would more than likely have become even heavier. The dangers of high pregnancy weight is, among other things, diabetes of pregnancy.
Dealing with the situation now will prevent problems in the future. Certainly a an excellent reason to avoid recourse to surgery for managing your pregnancy weight risks.