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A Longitudinal Study of Respiratory Mechanics in Pregnant Women with Obesity and Overweight

  • PULMONARY FUNCTION IN PREGNANCY
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Abstract

Purpose

Respiratory mechanics and the role of sex hormones in pregnancy are not well elucidated. We examined longitudinal and positional changes in lung mechanics in pregnancy and investigated the role of sex hormones.

Methods

A longitudinal study enrolled 135 women with obesity in early pregnancy. Fifty-nine percent of women identified as White; median body mass index at enrollment was 34.4 kg/m2. Women with respiratory disease were excluded. We obtained measurements of airway resistance and respiratory system reactance in various positions using impedance oscillometry and sex hormones in early and late pregnancy.

Results

With pregnancy progression, there was a significant increase in resonant frequency (Fres) (p = 0.012), integrated area of low frequency reactance (AX) (p = 0.0012) and R5-R20Hz (p = 0.038) in the seated position, and a significant increase in R5Hz (p = 0.000), Fres (p = 0.001), AX (p < 0.001 = 0.000), and R5-R20Hz (p = 0.014) in the supine position. Compared to the seated position, the supine position was associated with a significant increase in R5Hz, R20Hz, X5Hz, Fres, and AX in early (p-values < 0.026) and late pregnancy (p-values ≤ 0.001). Changes in progesterone levels between early and late pregnancy predicted the change in R5, Fres, and AX (p-values ≤ 0.043).

Conclusion

Resistive and elastic loads increase with pregnancy progression and a change in body position from seated to supine increases resistive and elastic loads in both early and late pregnancies. The increase in airway resistance is primarily related to an increase in peripheral rather than central airways resistance. There was an association between the change in progesterone levels and airway resistance.

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Data Availability

The deidentified data of this study and a data dictionary defining each field in the set will be made available from the corresponding author upon reasonable request once planned data analyses are completed.

Abbreviations

AX:

Integrated area of low-frequency reactance

BMI:

Body mass index

C:

Elastance or capacitance

ERV:

Expiratory reserve volume

FRC:

Functional residual capacity

Fres:

Resonant frequency

I:

Inertance

IOS:

Impulse oscillometry

IQR:

Interquartile range

R:

Resistance

R5:

Resistance at 5 Hz

R20:

Resistance at 20 Hz

RV:

Residual volume

TLC:

Total lung capacity

VC:

Vital capacity

X:

Reactance

X5:

Reactance at 5 Hz

Z:

Impedance (sum of resistance and reactance)

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Funding

Funding and support were available through the National Heart, Lung, and Blood Institute R01HL130702 (GB) and the National Institute of Child Health and Human Development R01HD078515 (GB), the National Heart, Lung, and Blood Institute R01HL157288 (MHB), and the National Institute of General Medical Sciences 5P20GM103652 (MHB).

Author information

Authors and Affiliations

  1. Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA

    Ghada Bourjeily, Laura Sanapo & F. Dennis McCool

  2. Women’s Medicine Collaborative, The Miriam Hospital, 146 West River St., Providence, RI, 02904, USA

    Ghada Bourjeily, Laura Sanapo, Margaret H. Bublitz, Beth Hott, Melissa Guillen, Annaly Aldana, Ashanti Avalos, Tamara Sequeira & Cynthia Brosnan

  3. Departments of Obstetrics and Gynecology and Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Geralyn Messerlian

  4. Women and Infants Hospital, 101 Dudley St., Providence, RI, 02905, USA

    Geralyn Messerlian

  5. Departments of Medicine, and Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Margaret H. Bublitz

  6. Department of Pathology and Laboratory Medicine, Women and Infants Hospital, 101 Dudley St., Providence, RI, 02905, USA

    Cheryl Felber

  7. Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA, 02215, USA

    Talal El Zarif

  8. Women’s Medicine Collaborative, The Miriam Hospital, 146 West River St., Suite 1F, Providence, RI, 02904, USA

    Ghada Bourjeily

Authors
  1. Ghada Bourjeily
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  2. Laura Sanapo
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  3. Geralyn Messerlian
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  5. Beth Hott
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  7. Annaly Aldana
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  9. Tamara Sequeira
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  10. Cheryl Felber
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  11. Cynthia Brosnan
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  13. F. Dennis McCool
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Contributions

Conceptualization: GB and FM, data curation: GB, BH, LS, TEZ, FM, MB, GM, formal analysis: GB and MB, funding acquisition: GB, investigation: GB, LS, AA, AA, TS, CB, MG, FM, CF, GM, methodology: FM, GM, GB, project administration: GB, LS, MB, resources, software, supervision: GB, LS, validation, visualization, writing the original draft of the manuscript: GB, and review & editing of the manuscript: GB, GM, TEZ, LS, MB. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ghada Bourjeily.

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Competing interests

The authors declare no competing interests.

Ethical Approval

This is an observational study. This study was approved by Lifespan Institutional Review Board #781944 on 09/23/2015.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

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Bourjeily, G., Sanapo, L., Messerlian, G. et al. A Longitudinal Study of Respiratory Mechanics in Pregnant Women with Obesity and Overweight. Lung 201, 371–379 (2023). https://doi.org/10.1007/s00408-023-00633-7

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  • DOI: https://doi.org/10.1007/s00408-023-00633-7

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