Obesity, obstetric complications and cesarean delivery rate–a population-based screening study

doi:10.1016/j.ajog.2003.09.058

American Journal of Obstetrics and Gynecology

Volume 190, Issue 4, April 2004, Pages 1091-1097

https://doi.org/10.1016/j.ajog.2003.09.058 Get rights and content

Abstract

Objective

This study was undertaken to determine whether obesity is associated with obstetric complications and cesarean delivery.

Methods

A large prospective multicenter database was studied. Subjects were divided into 3 groups: body mass index (BMI) less than 30 (control), 30 to 34.9 (obese), and 35 or greater (morbidly obese). Groups were compared by using univariate and multivariable logistic regression analyses.

Results

The study included 16,102 patients: 3,752 control, 1,473 obese, and 877 morbidly obese patients. Obesity and morbid obesity had a statistically significant association with gestational hypertension (odds ratios [ORs] 2.5 and 3.2), preeclampsia (ORs 1.6 and 3.3), gestational diabetes (ORs 2.6 and 4.0), and fetal birth weight greater than 4000 g (ORs 1.7 and 1.9) and greater than 4500 g (ORs 2.0 and 2.4). For nulliparous patients, the cesarean delivery rate was 20.7% for the control group, 33.8% for obese, and 47.4% for morbidly obese patients.

Conclusion

Obesity is an independent risk factor for adverse obstetric outcome and is significantly associated with an increased cesarean delivery rate.

Section snippets

Methods

The First and Second Trimester Evaluation of Risk (FASTER) trial, a National Institute of Child Health and Human Development (NICHD) sponsored study, is a prospective multicenter investigation of singleton pregnancies from an unselected obstetric population. This study evaluated first trimester nuchal translucency along with first and second trimester serum markers for the purpose of assessing Down syndrome risk. A database was created containing detailed antenatal, birth, and pediatric

Results

A total of 16,102 records with complete antenatal, birth, and pediatric outcomes were available for review at the time this analysis was performed. The control group consisted of 13,752 (85%) patients, the obese group consisted of 1,473 (9%) patients, and the morbidly obese group consisted of 877 (6%) patients. The demographic characteristics are summarized in Table I. Statistically significant differences were noted between the groups for age, race, education, marital status, parity, and prior

Comment

Studies on maternal and fetal outcomes of pregnancies complicated by obesity have reported varied results.5., 6., 7., 8., 9., 10., 11., 12., 13., 14., 15., 16., 17., 18., 19., 20., 21. The majority of studies have described an increased risk for gestational hypertension, preeclampsia, and gestational diabetes associated with obesity.5., 6., 8., 9., 10., 11., 12., 13., 22. Outcomes regarding postpartum hemorrhage, urinary tract infections, wound infections, fetal macrosomia, IUGR, intrauterine

Acknowledgements

We acknowledge the work of the members of the FASTER Research Consortium: K. Welch, MS, R. Denchy, MS (Columbia University, New York, NY); F. Porter, MD, L. Cannon, BS, K. Nelson, BSN, C. Loucks, RNC, A. Yoshimura (University of Utah, and IHC Perinatal Centers, Salt Lake City, Provo, and Ogden, Utah); D. Luthy, MD, S. Coe, MS (Swedish Medical Center, Seattle, Wash); J. Esler, BS (William Beaumont Medical Center, Royal Oak, Mich); G. Hankins, MD, R. Bukowski, MD, J. Lee MS, (UTMB Galveston,

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Obesity causes significant morbidity and increases the mortality risk for both mother and fetus. With an increasing projected prevalence, it is vital that the obstetric anesthetist is equipped with the knowledge and tools to manage these women. A multi-disciplinary team approach and early planning is required. Neuraxial analgesia for labor helps to negate the need for general anesthesia, which is associated with increased risk in this subset of women. Catheter techniques for neuraxial anesthesia allow for titration, manipulation, and prolongation of the anesthetic block to reduce the risk of conversion to general anesthesia.
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Women with obesity have higher rates of complications following cesarean delivery, such as wound infection and endometritis, with risks being the highest if a cesarean delivery is performed after labor. Previous efforts at predicting whether a patient's labor course would ultimately result in cesarean delivery have been intermediate with area under the curve in the 0.75 to 78 range.
This study aimed to assess whether machine learning algorithms would outperform traditional modeling in developing a cesarean delivery prediction model among gravidas with morbid obesity (body mass index of ≥40 kg/m²) to determine whether a primary cesarean delivery may be beneficial.
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Increasing maternal body mass index is associated with increased morbidity at cesarean delivery in a dose-dependent manner. In some clinical scenarios, operative vaginal delivery is a strategy to prevent the morbidity associated with second-stage cesarean delivery, but the relationship between maternal body mass index and outcomes of attempted operative vaginal delivery is not well characterized.
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This was a secondary analysis from the prospective cohort Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study. This analysis included cephalic live-born nonanomalous singleton pregnancies ≥34 weeks at delivery with an attempted operative vaginal delivery (either forceps or vacuum). The primary exposure was maternal body mass index at delivery (≥30 vs <30 kg/m² [referent]). The primary outcome was an unsuccessful operative vaginal delivery attempt, defined as a cesarean delivery after an attempted operative vaginal delivery. The secondary outcomes included maternal and neonatal adverse outcomes. Multivariable logistic regression was used, and statistical interaction between operative instrument type (vacuum vs forceps) and body mass index was assessed.
Of 10,038 assessed individuals, 791 (7.9%) had an attempted operative vaginal delivery and were included in this analysis. Of note, 325 individuals (41%) had a body mass index ≥30 kg/m² at delivery. Overall, 42 of 791 participants (5%) experienced an unsuccessful operative vaginal delivery. Individuals with a body mass index ≥30 kg/m² at delivery were more than twice as likely to have an unsuccessful operative vaginal delivery than those with a body mass index <30 kg/m² (8.0% vs 3.4%; adjusted odds ratio, 2.23; 95% confidence interval, 1.16–4.28; P=.005). Composite maternal morbidity and composite neonatal morbidity did not vary by body mass index group. There was no evidence of interaction or effect modification by operative instrument type for the rate of unsuccessful operative vaginal delivery attempt, composite maternal morbidity, or composite neonatal morbidity.
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class III obese women, are at a higher risk of cesarean section during labor, and cesarean section is responsible for increased maternal and neonatal morbidity in this population. Objective: the objective of this project was to develop a method with which to quantify cesarean section risk before labor.
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this is an innovative and effective approach to predicting unplanned CS risk in this population and could play a role in the choice of a trial of labor versus planned cesarean section. Further studies are needed, especially a prospective clinical trial. Funding: French state funds “Plan Investissements d'Avenir” and Agence Nationale de la Recherche.

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^☆: Supported by Grant Number RO1 HD 38652 from the National Institutes of Health and the National Institute of Child Health and Human Development.

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General obstetrics and gynecology: obstetricsObesity, obstetric complications and cesarean delivery rate–a population-based screening study☆

Abstract

Objective

Methods

Results

Conclusion

Section snippets

Methods

Results

Comment

Acknowledgements

Am J Obstet Gynecol

Obstet Gynecol

Int J Gynecol Obstet

Obstet Gynecol

Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Sem Perinatol

Am J Obstet Gynecol

Am J Obstet Gynecol

Obstet Gynecol

Am J Obstet Gynecol

Plan and operation of the second National Health and Nutrition Examination Survey, 1976-1980

Increasing prevalence of overweight among Wisconsin adults, 1989-1998

WMJ

Caring for obese obstetric patients

Contemp Obstet Gynecol

General obstetrics and gynecology: obstetrics
Obesity, obstetric complications and cesarean delivery rate–a population-based screening study☆