Maternal obesity as an independent risk factor for caesarean delivery

Abstract

The present study was aimed to investigate pregnancy outcome among obese women and specifically the correlation between maternal obesity and incidence of caesarean section (CS) while controlling for the potential confounding effects of other variables associated with obesity. A population-based study was performed comparing all pregnancies of obese (maternal pre-pregnancy body mass index (BMI) of 30 kg/m2 or more) and non-obese patients, between the years 1988 and 2002. Patients with hypertensive disorders and diabetes mellitus as well as patients lacking prenatal care were excluded from the analysis. Stratified analyses, using the Mantel-Haenszel technique, and a multiple logistic regression model were performed to control for confounders. During the study period there were 126,080 deliveries meeting the inclusion criteria, of which 1769 (1.4%) occurred in obese patients. Using a multivariable analysis, the following conditions were significantly associated with maternal obesity: failure to progress during the first stage (odds ratio (OR) = 3.1; 95% confidence interval [CI] 2.5, 3.8; P < 0.001), fertility treatments (OR = 2.0; [95% CI 1.6, 2.5]; P < 0.001), previous CS (OR = 1.7; [95% CI 1.5, 1.9]; P < 0.001), malpresentations (OR = 1.4; [95% CI 1.2, 1.6]; P < 0.001), recurrent miscarriages (OR = 1.4; [95% CI 1.2, 1.7]; P < 0.001) and fetal macrosomia (OR = 1.4; [95% CI 1.2, 1.7]; P < 0.001). Higher rates of caesarean deliveries were found among obese parturients (27.8% vs. 10.8%; OR = 3.2; [95% CI 2.9, 3.5]; P < 0.001). When controlling for possible confounders, using the Mantel-Haenszel technique, the association between maternal obesity and CS remained significant. No significant differences were noted between the groups regarding perinatal complications such as perinatal mortality, congenital malformations, shoulder dystocia and low Apgar scores. In conclusion, a significant association was found between obesity and CS even after the exclusion of hypertensive disorders and diabetes mellitus. Importantly, obesity alone was not associated with adverse perinatal outcome. Obstetricians should be encouraged to allow obese patients not suffering from diabetes or hypertensive disorders an adequate trial of labour.

Body mass index has a greater impact on pregnancy outcomes than gestational hyperglycaemia

“…There is ample consensus that GDM and obesity/overweight have a negative effect on pregnancy outcome [2][3][4][5][6][7][8][9][10][11][12]. However, few studies have attempted to discern the relative influences of overweight and GDM [22][23][24][25][26][27].…”

“…The same is true for obesity, for which the risks include higher rates of GDM, hypertension, pre-eclampsia and macrosomia [2][3][4][5][6][7][8][9][10][11][12]. The rate of overweight and obesity has increased steadily around the world over the past 20 years, affecting all age groups and including women of reproductive age [13,14].…”

Factors Related to the High Cesarean Section Rate and Their Effects on the "Price Transparency Policy" in Beijing, China

“…In this study, two indices were also created according to previous literatures (Sheiner et al 2004) (Appendix A). Index 1, which refers to the Complication Index, was calculated by summing up 17 dichotomous (yes or no) variables, and ranging from 0 to 17.…”

82: Contemporary labor patterns: the impact of maternal body mass index

“…5,6 The explanation for this finding is unknown, but several theories have been proposed, including greater fetal size, soft tissue obstruction to labor, poor uterine contractility, more frequent inductions as a result of pregnancy complications, or care-giver biases. [6][7][8][9][10][11] The Friedman curve is a well-known figure to all clinicians who participate in the management of labor and delivery. However, the evaluation of labor progression is largely based on studies from the 1950's which described patients from a small homogeneous population.…”