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Objective In nonpregnant populations the waist to hip ratio (WHR) is a better predictor of obesity related outcomes than BMI. Our objective was to determine, in pregnancy, the relationship between these measures of obesity and LGA and cesarean delivery (CD). Methods This is a secondary analysis of data from the Combined Antioxidant and Preeclampsia Prediction Study (CAPPS). Women a WHR of ≥0.85 and 0.80–0.84 at 9–16 weeks gestation, were compared to those with a WHR <0.80. Women with early pregnancy BMI ≥ 30.0 kg/m2 (obese) and 25.0–29.9 kg/m2 (overweight) were compared to those <25.0 kg/m2. LGA was defined as >90% by Alexander nomogram. Univariable analysis, logistic regression and ROC curves were used. Results Data from 2,276 women were analyzed. After correcting for potential confounders, only BMI ≥ 30 was significantly associated with LGA (aOR 2.07, 1.35–3.16) while BMI 25.0–29.9 (aOR 1.5, 0.98–2.28), WHR 0.8–0.84 (aOR 1.33, 0.83–2.13) and WHR≥0.85, (aOR 1.05, 0.67–1.65) were not. Risk for CD was increased for women with elevated WHR and with higher BMI compared to normal. Conclusion WHR is not associated with LGA. While BMI performed better than WHR, neither was a strong predictor of LGA or need for CD in low risk nulliparous women.

Objective  Morbidly adherent placentation is associated with increased maternal morbidity and mortality. Recently, there has been mounting evidence supporting the benefits of a standardized multidisciplinary approach at tertiary teaching hospitals. Our objective was to estimate the impact of the implementation of a similar program at a high-volume private community hospital. Study Design  In this retrospective cohort study, we evaluated maternal outcomes in all cases of histopathologically confirmed morbidly adherent placentation since the initiation of our multidisciplinary program (2012–2016). Our data were compared with the previously published outcomes of two large cohorts from tertiary teaching hospitals in Utah and Texas. Results  In the 28 cases included for evaluation, our group's median estimated blood loss, median packed red blood cells transfused, median anesthesia time, median length of stay, or rates of maternal morbidity did not statistically differ from the published data in Utah or Texas. Conclusion  Our data demonstrate the feasibility and utility of a multidisciplinary morbidly adherent placentation program in the private practice/community hospital setting with outcomes similar to those at tertiary teaching hospitals. Implementation of such program may prove beneficial in remote centers, where various factors may prohibit patient travel to a larger center.