Does increasing body mass index affect cerclage efficacy?

Abstract

Objective: To study the relationship between body mass index (BMI) and gestational age (GA) at delivery in patients with cervical insufficiency (CI) undergoing cerclage.Study Design: We accessed a database of patients with singleton gestations undergoing cerclage (N ¼ 168) for a well-characterized history of CI, shortened cervix <2.5 cm with a history of prior preterm delivery or prolapse of membranes through the external os. Univariate and multivariate logistic regression analysis were performed to compare obstetrical outcomes between obese and normal-weight patients.Result: Prior preterm delivery <35 weeks in obese vs normal-weight patients was significantly higher (44% vs 9%), odds ratio ¼ 6.9 (95% CI: 2.5, 18.5), with lower mean GA at delivery (32.6 ± 7.0 vs 37.2 ± 3.4 weeks, P<0.001). After controlling for confounders, BMI remained significantly predictive of prematurity (coefficient: À0.12, adjusted R 2 ¼ 0.24), such that every additional 1 unit of BMI was associated with a 1-day reduction in GA at delivery (P ¼ 0.03).Conclusion: An inverse correlation exists between BMI and GA at delivery in patients with CI receiving cerclage. The findings are unexpected given the protective effect of obesity on spontaneous preterm delivery.

Recurrence of second trimester miscarriage and extreme preterm delivery at 16–27 weeks of gestation with a focus on cervical insufficiency and prophylactic cerclage

“…A disadvantage of this study is the absence of data on potential confounders such as body mass index, ethnicity, smoking and alcohol habits and social class, which have been proved to be risk factors of second trimester miscarriage or extreme preterm delivery . Non‐validated diagnoses are a limitation in register‐based studies, especially those diagnoses without a clear definition.…”

Maternal Prepregnancy Body Mass Index and Risk of Spontaneous Preterm Birth

“…30 There is also some evidence that among women with cervical insufficiency (potentially greatest in the 20-23 week group), obesity may be associated with decreased gestational age at delivery. 31 This large-scale study cannot identify specific mechanisms underlying the association between prepregnant weight (underweight and obesity) and risk of spontaneous preterm birth. Importantly, however, our study does identify segments of the population that may offer clues as to where to initiate mechanistic studies that can improve our understanding and prevention of preterm birth.…”

“…Indeed, changes in gut microbiome also have been implicated in substantive changes in a pregnant woman's metabolism and can induce symptoms akin to metabolic syndrome in non‐pregnant mice . There is also some evidence that among women with cervical insufficiency (potentially greatest in the 20–23 week group), obesity may be associated with decreased gestational age at delivery …”

Effect of body mass index on latency periods after history-indicated cervical cerclage

“…Our study did not include a morbid obese subgroup, so it is impossible to compare our results with this study. Poggi et al . reviewed prophylactic, ultrasound/history‐indicated and physical examination‐indicated cerclage procedures.…”

“…Interestingly, there are only a few studies investigating the impact of BMI on cervical cerclage success. The gestational age of delivery of women with cervical cerclage was found to be lower when the maternal BMI was higher . However, another study reported no effect of BMI on ultrasound‐indicated cervical cerclage outcomes …”