Maternal and perinatal outcomes for women with body mass index ≥50 kg/m² in a non‐tertiary hospital setting

Abstract

Background: Obesity is prevalent in the Australian antenatal population, but there are scarce data on the prevalence and associated outcomes of body mass index (BMI) ≥50 kg/m 2 . Aims: To examine the prevalence and outcomes for women with BMI ≥50 kg/m 2 delivering in a non-tertiary hospital. Materials and Methods:Retrospective cohort study of women delivering a singleton pregnancy in a non-tertiary Victorian hospital during 2011-2016. Women >180 kg were excluded as their care was managed in a tertiary centre. Maternal and perinatal outcomes were analysed by BMI group. Statistical analysis was performed using χ 2 , Kruskal-Wallis and logistic regression with a significance level of 0.05. Results:Of the 18 518 births between 2011 and 2016, 99.4% had a maternal BMI recorded. The prevalence of BMI ≥50 kg/m 2 was 0.5%. Highest complication rates were observed among women with BMI ≥50 kg/m 2 , including gestational diabetes (29%), hypertensive disorders of pregnancy (20%) and caesarean section (48%). Of infants born to women with BMI ≥50 kg/m 2 , 12% were late-pre-term, 23% required special or intensive care and 20% had birth weight ≥4.0 kg. When compared with obese women with BMI 30-49 kg/m 2 , women with BMI ≥50 kg/m 2 were significantly more likely to develop a hypertensive disorder of pregnancy (preeclampsia adjusted odds ratio (aOR) 3.98 (1.93-8.18), pregnancy-induced hypertension aOR 3.55 (1.79-7.03)) and deliver a late pre-term infant (aOR 2.45 (1.31-4.58)). Conclusions:The prevalence of severe maternal obesity in our non-tertiary setting is higher than previous national estimates. Women with BMI ≥50 kg/m 2 are an important subgroup of the obese obstetric population who experience high rates of complications and interventions. Health services need to respond to evolving needs of the antenatal population to achieve the best outcomes for mothers and babies. K E Y W O R D SBMI, maternal obesity, maternal outcomes, perinatal outcomes, severe obesity SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section at the end of the article. Table S1. Listed categories of indications for induction of labour.

Obesity, Pregnancy and Lifestyle Clinic: Evaluation and Outcomes

“…In line with previous studies of the population of pregnant women attending Northern Health, our study demonstrates that women with an elevated BMI experience a high degree of obstetric and neonatal complications, as well as an increased rate of birth interventions (3). This is also consistent with the broader literature describing the risks associated with maternal obesity in pregnancy.…”

“…This is particularly true for The Northern Hospital, a non-tertiary Victorian hospital servicing the Northern Growth Corridor of Melbourne, an area of high population growth and signi cant cultural and socio-economic diversity. Pregnant women attending The Northern Hospital have an increased rate of obesity compared to the general Australian population; of the women who gave birth at The Northern Hospital between 2011 and 2016, 31.6% were overweight (BMI 25-29kg/m 2 ) and 28.3% were obese (BMI ≥ 30), of which 4.8% fell into obese class III (3).…”

Assessing maternal clotting function with novel global coagulation assays: A prospective pilot study

“…One of our study limitations was that BMI was not available for our nonpregnant cohort, and we were therefore unable to adjust for this factor when comparing the nonpregnant group to the obstetric cohort. As our recruitment was largely from elective caesarean theatre lists, we acknowledge that our pregnant cohort may not represent the general obstetric population as caesarean births are known to be associated with higher maternal age, parity and BMI 37,38 . Our pregnant cohort also had a relative high rate of gestational diabetes mellitus (GDM) (31.7%) when compared with our institution's general obstetric population (14.7%) 37 .…”

“…As our recruitment was largely from elective caesarean theatre lists, we acknowledge that our pregnant cohort may not represent the general obstetric population as caesarean births are known to be associated with higher maternal age, parity and BMI 37,38 . Our pregnant cohort also had a relative high rate of gestational diabetes mellitus (GDM) (31.7%) when compared with our institution's general obstetric population (14.7%) 37 . This was likely due to the timing of study recruitment at the beginning of the morning operating lists, when women with GDM are preferentially scheduled for their caesarean births.…”

Predictors of Adverse Pregnancy Outcomes in Pregnant Women Living with Obesity: A Systematic Review

“…Inspection of these citations by two reviewers excluded a total of 6692 citations due to not meeting inclusion criteria, leading to 1202 articles for review at full text. Amongst these citations, a total of 1141 were excluded by reviewers (reasons provided in Figure 1 ), leaving a total of 61 publications for final inclusion [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ,…”