Influence of Obesity on Maternal and Neonatal Outcomes in Advanced Maternal Age Women [22D]

Abstract

INTRODUCTION: Advanced maternal age (AMA) and obesity have been shown to independently influence maternal and neonatal outcomes. We sought to determine if obese AMA women had greater risk for adverse outcomes compared to non-obese AMA women. METHODS: A retrospective cohort study of non-anomalous, singleton AMA (age 35+) pregnancies at Oregon Health & Science University from 2009–2014 to assess if obesity (pre-pregnancy BMI 30+) impacted outcomes above AMA status alone. Maternal outcomes included gestational diabetes (GDM), pre-eclampsia (PET), and cesarean section (CS). Neonatal outcomes included NICU admission, SGA/LGA, preterm birth, and hypoglycemia. Univariate analyses were used to determine significant differences between groups (P<.05), and multivariate logistic regression adjusting for biologically plausible confounders was utilized to determine strength of association. RESULTS: Of the 7,953 deliveries during the study period, 1,712 were to AMA women with 459 obese (27%) and 1,253 non-obese (73%). Obese AMA women were associated with significantly increased rates of GDM (aOR 3.04, 95% CI 2.23–4.40), PEC (aOR 1.64, 95% CI 1.09–2.47), and CS (aOR 1.42, 95% CI 1.12–1.85). Neonates born to obese AMA women were associated with significantly increased rates of LGA (aOR 2.66, 95% CI 1.86–3.80) and hypoglycemia (aOR 1.98, 95% CI 1.10–3.58). There was no significant association between obesity in AMA women and SGA, preterm birth, or NICU admission. CONCLUSION: In AMA pregnancies, obesity is associated with significantly increased rates of GDM, PEC, CS, LGA neonates, and neonatal hypoglycemia. These results suggest that AMA pregnancies complicated by maternal obesity may benefit from earlier intervention and counseling.

Providing bias-informed and evidence-based care for pregnant persons with obesity

“…17 The stigma surrounding the diagnosis of obesity can be seen in past recommendations in which pregnancy care was heavily focused on intervention for patients with a BMI over 30 kg/m 2 . 12,18 The current recommendations focus on collaboration between low-and high-risk providers, and the result of this trend toward collaborative practices has improved patient outcomes. 9,19 In support of this, a growing body of research shows improved outcomes when the pregnant person has access to the Midwifery Model of Care-a model very familiar to women's health nurse practitioners.…”

Impact of Normal and Overweight Pregnant Women upon Neonatal Outcomes in Al-Nasiriya Hospitals :Comparative Study

“…Liu et al, (2013) found that of neonatal intensive care admission (AOR, 2.07; 95% CI, 1.32-3.23) and Apgar score of under 7 at 5 minutes (95%) in overweight compared with normal weight [20] . Also Hartge et al, (2016) , and Hanneman et al,( 2020) found that neonates born to obese women were associated with significantly increased rates of hypoglycemia (95%) [21,22] . 2014) who found no significant association between women weight and neonatal outcomes, risks of stillbirth, neonatal death, preterm birth, congenital anomaly, and low birth weight [22,23,24] .…”

“…Also Hartge et al, (2016) , and Hanneman et al,( 2020) found that neonates born to obese women were associated with significantly increased rates of hypoglycemia (95%) [21,22] . 2014) who found no significant association between women weight and neonatal outcomes, risks of stillbirth, neonatal death, preterm birth, congenital anomaly, and low birth weight [22,23,24] .…”