Linear association between maternal pre‐pregnancy body mass index and risk of caesarean section in term deliveries

Barau, G.; Py, Robillard; Tc, Hulsey; Dedecker, F.; Laffite, A.; Gérardin, Patrick; Kauffmann, E.

doi:10.1111/j.1471-0528.2006.01038.x

Cited by 136 publications

(109 citation statements)

References 16 publications

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“…Obesity in the present study was associated with a higher rate of CS (42.9%). Similar findings were reported by others [27,28] and a linear relationship between BMI and cesarean delivery has been reported [29].…”

Section: Discussionsupporting

confidence: 79%

Cesarean Section: Incidence, Causes, Associated Factors and Outcomes: A National Prospective Study from Jordan

Batieha¹,

Sa²,

Ys³

et al. 2017

Gynecol Obstet Case Rep

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Objectives: To determine the rate of cesarean section (CS) in Jordan and its causes, associated factors, and neonatal outcomes. Methods:The study is part of a comprehensive national study of perinatal mortality which was conducted between 2011 and 2012 in Jordan. The study was concurrent prospective in design. A sample of 18 hospitals with maternity departments was selected. All women ≥ 20 weeks of gestation admitted for delivery in any of the 18 selected hospitals were enrolled in the study. Data were collected by interviews and abstraction of data from medical records. Results:The overall rate of CS was 29.1% (13.2% as emergency CS and 15.9% as planned CS). Health sector, income of >350, <12 years of education, increased gestational age at delivery, primiparity, previous CS, male gender, overweight, obesity, pre-gestational and gestational diabetes, non-cephalic presentation, multiple pregnancy, preeclampsia, anemia, smoking, history of neonatal death/stillbirth, and previous hospitalization during current pregnancy were all associated with increased odds of CS in the multivariate analysis. The most frequent reason for planned CS was scarred uterus (59.4%) and for emergency CS was prolonged fetal distress (30.0%). The neonatal death rate was significantly higher (p=0.000) for planned CS (2.1%) and emergency CS (2.5%) as compared to vaginal delivery (0.9%). Conclusion:The rate of CS in Jordan is high (29.1%). CS is associated with increased risk of neonatal death. As most CSs are currently based on physician's judgment, it may be extremely useful to develop and implement national guidelines for performing CS. Obstetricians' adherence to these guidelines should be strictly monitored.

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Section: Discussionsupporting

confidence: 79%

Cesarean Section: Incidence, Causes, Associated Factors and Outcomes: A National Prospective Study from Jordan

Batieha¹,

Sa²,

Ys³

et al. 2017

Gynecol Obstet Case Rep

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“…It has been shown that even with an uncomplicated pregnancy, there was a need for more oxytocin infusion to induce labor in overweight and obese women than in normal weight (42). Moreover, prepregnancy body mass index (43,44) and increase in its category (45) during pregnancy have been found to be high risk factors for caesarean delivery at term of pregnancy for failure to progress in the labor. However, the molecular mechanisms by which obesity and overweight lead to difficult labor remain unknown so far.…”

Section: Discussionmentioning

confidence: 99%

Oxysterol Nuclear Receptor LXRβ Regulates Cholesterol Homeostasis and Contractile Function in Mouse Uterus

Mouzat

Prod'homme

Volle

et al. 2007

Journal of Biological Chemistry

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The uterus is an organ where lipid distribution plays a critical role for its function. Here we show that nuclear receptor for oxysterols LXR␤ prevents accumulation of cholesteryl esters in mouse myometrium by controlling expression of genes involved in cholesterol efflux and storage (abca1 and abcg1). Upon treatment with an LXR agonist that mimics activation by oxysterols, expression of these target genes was increased in wild-type mice, whereas under basal conditions, lxr␣;␤ ؊/؊ mice exhibited a marked decrease in abcg1 accumulation. This change resulted in a phenotype of cholesteryl ester accumulation. Besides, a defect of contractile activity induced by oxytocin or PGF2␣ was observed in mice lacking LXR␤. These results imply that LXR␤ provides a safety valve to limit cholesteryl ester levels as a basal protective mechanism in the uterus against cholesterol accumulation and is necessary for a correct induction of contractions.The uterus is schematically divided into two distinct zones: endometrium and myometrium. The endometrium, located in the inner part of the organ, is the site of blastocyst implantation, and its epithelium undergoes cyclic radical changes under the control of ovarian sex steroid hormones (1); estrogens are responsible for epithelial cell hyperplasia, whereas progesterone blocks cell proliferation and induces differentiation. The myometrium (2), in the outer part of the uterus, accounts for more than 60% of the whole organ (3) and has a primordial role in uterine function. Whereas muscle quiescence due to high progesterone levels is essential during most of the pregnancy (4), efficient myometrium contractility is fundamental for a normal labor (for a review, see Ref. 5). This switch results from a modification in the plasma ratio of estrogens to progesterone signal that acts as primary event of the parturition. These hormonal changes also induce an increase in the level of endometrial prostaglandins, which play a role in the initiation and maintenance of labor, acting via specific relaxatory or contractile receptors on myometrium initiating contractions (6). Interestingly, it has also been demonstrated that increased production of surfactant protein A by the fetal lung near term causes activation and migration of fetal amniotic fluid macrophages to the maternal uterus, where increased production of interleukin-1␤ activates NF-B, leading to labor (7,8). The inversion of the estradiol/progesterone ratio induces the expression of OXTR (oxytocin receptor). When activated by oxytocin, a neuropeptide produced by the pituitary, this receptor has a primordial contractile activity on the myometrium during labor. Besides, lipid distribution in myometrium is modified during pregnancy in humans. Although no change in total phospholipids occurs during pregnancy (9), modifications in membrane fluidity take place. Hence, transfers of omega 3 and omega 6 polyunsaturated fatty acids, essential for normal fetal growth and development, from the mother to the fetus have been suggested (10). Likewise, an incre...

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“…Post-dated pregnancies, induction of labor (IOL) and abnormal labor progression are more common in obese women. The rates of both elective and emergency CS successively increase with maternal BMI (11)(12)(13). Postoperative complications, including postpartum hemorrhage, anesthesiology complications, infections and thromboembolic complications, are also more common in obese women (9,14).…”

Section: Maternal Complications Associated With Obesitymentioning

confidence: 99%

Maternal obesity, duration of labor and the role of leptin

Carlhäll¹

2018

Linköping University Medical Dissertations

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Background: The prevalence of obesity substantially increases in pregnant women. Maternal obesity is associated with adverse maternal and neonatal outcomes. The increased risk for cesarean section present in obese women has been related to potential impaired uterine contractility. The mechanism that underlies this theory is not clear. In vitro studies have shown that leptin, produced by adipose tissue and the placenta, exerts an inhibitory effect on myometrial contractility. The aim of this thesis was to evaluate the labor process in relation to maternal body mass index (BMI) and the clinical role of leptin in this process.

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Linear association between maternal pre‐pregnancy body mass index and risk of caesarean section in term deliveries

Cited by 136 publications

References 16 publications

Cesarean Section: Incidence, Causes, Associated Factors and Outcomes: A National Prospective Study from Jordan

Cesarean Section: Incidence, Causes, Associated Factors and Outcomes: A National Prospective Study from Jordan

Oxysterol Nuclear Receptor LXRβ Regulates Cholesterol Homeostasis and Contractile Function in Mouse Uterus

Maternal obesity, duration of labor and the role of leptin

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