Prepregnancy Obesity and Primary Cesareans among Otherwise Low‐Risk Mothers in 38 U.S. States in 2012

Abstract

Background The United States has recently experienced increases in both its rate of obesity and its cesarean rate. Our objective was to use a new item measuring prepregnancy body mass index (BMI) on the U.S. Standard Certificate of Live Birth to examine at a population level the relationship between maternal obesity and primary cesarean delivery for women at otherwise low risk for cesarean delivery. Methods By 2012, 38 states with 86 percent of United States births had adopted the U.S. Standard Certificate. The sample was limited to the 2,233,144 women who had a singleton, vertex, term (37–41 weeks) birth in 2012 and no prior cesarean. We modeled the likelihood of a primary cesarean by BMI category, controlling for maternal socio-demographic and medical characteristics. Results Overall, 46.4 percent of otherwise low-risk mothers had a prepregnancy BMI in the overweight (25.1%) or obese (21.3%) categories, with the obese category distributed as follows: obese I (BMI 30.0–34.9, 12.4%); obese II (BMI 35.0–39.9, 5.5%); and obese III (BMI 40+, 3.5%). Obesity rates were highest among American Indian and Alaska Native (32.5%) and non-Hispanic black mothers (30.5%). After adjustment for demographic and medical risks, the adjusted risk ratios (95% confidence intervals) of cesarean for low-risk primiparas were: 1.61 (1.60–1.63) for obese I, 1.86 (1.83–1.88) for obese II, and 2.21 (2.18–2.25) for obese III mothers compared with mothers in the normal weight category. Discussion A relationship between prepregnancy obesity and primary cesarean delivery among relatively low-risk mothers remained even after controlling for social and medical risk factors.

Hospital‐ownership status and cesareans in the United States: The effect of for‐profit hospitals

“…Research has also found that payments are higher in for‐profit hospitals and that for‐profit hospitals have higher costs . Our analysis also supports many of the findings in the literature regarding risk factors for cesareans, including prepregnancy obesity, older maternal age, Black or Hispanic race/ethnicity, preterm labor, prepregnancy diabetes, and previous cesarean . We also found, like other researchers, that when other measures of socioeconomic status are included, race does not significantly affect the odds of cesarean .…”

A clinical study on indications for caesarean section among primigravida in a tertiary care centre

“…Research studies have consistently found an association between the increase in maternal age and an increase in CS [10,11]. As morbidity tends to increase with age, any group of women with advanced maternal age will include more individuals with age-related prenatal risk factors such as hypertension [12] diabetes mellitus and high Body Mass Index (BMI) compared with a similar group of younger pregnant women [13,14].…”

Cesarean section on a rise—Does advanced maternal age explain the increase? A population register-based study

“…Research studies have consistently found an association between the increase in maternal age and an increase in CS [14,15]. As morbidity tends to increase with age, any group of women with advanced maternal age will include more individuals with age-related prenatal risk factors such as hypertension [7,16] diabetes mellitus [10] and high Body Mass Index (BMI) compared with a similar group of younger pregnant women [17,18]. Furthermore, studies have found that more women in the advanced age-group develop pregnancy-related complications including gestational diabetes [19], preeclampsia, and placenta previa [7,20,21].…”