Super obesity in pregnancy: difficulties in clinical management

Martin, Angela; Krishna, Iris; Ellis, Jessica; Paccione, Rose; Badell, Martina

doi:10.1038/jp.2014.4

Cited by 18 publications

(24 citation statements)

References 57 publications

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“…Maternal obesity may be an independent risk factor for CS as it interferes with the progress of labour, specifically the arrest of dilation in active phase labour [ 13 ]. The higher rate of CS has been explained in other studies by the association of super-obesity with conditions such as gestational diabetes, gestational hypertension and preeclampsia [ 14 – 16 ], all of which were more prevalent in women in our study. This is consistent with other research including comparison with other obese women (BMI 30.0–49.9 kg/m 2 ) [ 5 ].…”

Section: Discussionsupporting

confidence: 67%

“…Hospital guidelines and other recommendations would suggest thromboprophylaxis for women in the study group who had caesarean sections is warranted. There is, however, little or no differentiation of risk according to degree of obesity [ 19 – 21 ]; although Martin et al highlights the dose–response of increased risk of thromboembolic events and eclampsia as BMI increases and suggests this can be usefully applied to other pregnancy-related complications [ 16 ]. This amplified risk of morbidity according to BMI is consistent with the Mbah study discussed earlier and showed a significantly increased risk of pre-eclampsia between super-obese women (BMI ≥ 50 kg/m 2 adjusted odds ratio 4.71 [4.20–5.28]) compared to women with Class III obesity (3.75 [3.59–3.92] [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…This allowed investigation of whether there was an increased clinical impact and associated burden on health services for women with super obesity. Martin et al [ 16 ] suggest the need for differential management of super-obese pregnant women compared to the lower range of BMI 40–49.9 kg/m 2 , including the need for larger antibiotic dosage for women with BMIs of >50 kg/m 2 to that of women with BMI of >35 kg/m 2 , and a need for more research on the specific anticoagulation requirements according to tiered classification of obesity [ 5 , 16 ]. A limitation of this approach is that it potentially decreases the capacity to detect difference in our study between the super-obese group and the comparison group in maternal and perinatal outcomes due to the inclusion of obese women in the comparison group.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study

Sullivan

Dickinson

Vaughan

et al. 2015

BMC Pregnancy Childbirth

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BackgroundSuper-obesity is associated with significantly elevated rates of obstetric complications, adverse perinatal outcomes and interventions. The purpose of this study was to determine the prevalence, risk factors, management and perinatal outcomes of super-obese women giving birth in Australia.MethodsA national population-based cohort study. Super-obese pregnant women (body mass index (BMI) >50 kg/m2 or weight >140 kg) who gave birth between January 1 and October 31, 2010 and a comparison cohort were identified using the Australasian Maternity Outcomes Surveillance System (AMOSS). Outcomes included maternal and perinatal morbidity and mortality. Prevalence estimates calculated with 95 % confidence intervals (CIs). Adjusted odds ratios (ORs) were calculated using multivariable logistic regression.Results370 super-obese women with a median BMI of 52.8 kg/m2 (range 40.9–79.9 kg/m2) and prevalence of 2.1 per 1 000 women giving birth (95 % CI: 1.96–2.40). Super-obese women were significantly more likely to be public patients (96.2 %), smoke (23.8 %) and be socio-economically disadvantaged (36.2 %). Compared with other women, super-obese women had a significantly higher risk for obstetric (adjusted odds ratio (AOR) 2.42, 95 % CI: 1.77–3.29) and medical (AOR: 2.89, 95 % CI: 2.64–4.11) complications during pregnancy, birth by caesarean section (51.6 %) and admission to special care (HDU/ICU) (6.2 %). The 372 babies born to 365 super-obese women with outcomes known had significantly higher rates of birthweight ≥4500 g (AOR 19.94, 95 % CI: 6.81–58.36), hospital transfer (AOR 3.81, 95 % CI: 1.93–7.55) and admission to Neonatal Intensive Care Unit (NICU) (AOR 1.83, 95 % CI: 1.27–2.65) compared to babies of the comparison group, but not prematurity (10.5 % versus 9.2 %) or perinatal mortality (11.0 (95 % CI: 4.3–28.0) versus 6.6 (95 % CI: 2.6- 16.8) per 1 000 singleton births).ConclusionsSuper-obesity in pregnancy in Australia is associated with increased rates of pregnancy and birth complications, and with social disadvantage. There is an urgent need to further address risk factors leading to super-obesity among pregnant women and for maternity services to better address pre-pregnancy and pregnancy care to reduce associated inequalities in perinatal outcomes.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study

Sullivan

Dickinson

Vaughan

et al. 2015

BMC Pregnancy Childbirth

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“…Nearly 80% of our cohort was obese and African American. The obesity epidemic in the United States continues, and this is especially prominent in the South and among African American women . The possibility of an LFF result may also increase with this growing epidemic, and providers are encouraged to discuss the possibility of an LFF result, in particular with obese African American women.…”

Section: Discussionmentioning

confidence: 99%

Adverse perinatal outcomes are more frequent in pregnancies with a low fetal fraction result on noninvasive prenatal testing

et al. 2016

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Objective This study aimed to assess risk of an adverse perinatal outcome for women with a low fetal fraction (LFF) result on noninvasive prenatal testing (NIPT).Study Design A retrospective cohort study whereby women with an LFF result were compared with women who had a sufficient fetal fraction (SFF) result on NIPT. Inclusion criteria were singleton pregnancies with quantification of fetal fraction and pregnancy outcome information. Primary outcome was a composite of any of the following: miscarriage, fetal demise, neonatal death, preterm birth, pregnancy-associated hypertensive disorder, placental abruption, and low birth weight.Results Three hundred forty-eight (94%) women had an SFF result, and 22 (6%) women had an LFF result. The mean gestational age at the time of NIPT was comparable for both groups. Women with an LFF result were more likely to be African American (86% vs 52%; p = 0.007) and have a higher body mass index (BMI) (mean BMI = 37 kg/m 2 vs BMI = 29 kg/m 2 ; p ≤ 0.001) than women with an SFF result. The composite outcome was significantly more common in the LFF group (59.1% vs 29%; p = 0.003). After adjusting for race and BMI, LFF remained independently associated with adverse perinatal outcome with adjusted odds ratio = 2.5 (95% confidence interval 1.01-6.2; p = 0.049).Conclusions Women with an LFF result have an increased likelihood of an adverse pregnancy outcome.

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“…HPs felt that caring for obese women required more time and work in a setting with limited resources, a theme similar to challenges identified in maternity settings 18 and reflective of additional considerations required for providing their maternity care. 19 HPs also felt obese women were more difficult to care for because of their complex medical issues and difficulties with finding successful breastfeeding positions. The combination of an obese woman's concern for exposing her body, general exhaustion, and a difficult postpartum course posed more challenges.…”

mentioning

confidence: 99%

Health Professionals' Experiences Providing Breastfeeding-Related Care for Obese Women

Garner

Ratcliff

Devine

et al. 2014

Breastfeeding Medicine

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Background: Obese women are at high risk of early breastfeeding cessation, and health professionals (HPs) have a unique opportunity to provide them with breastfeeding support. Our objective was to describe HPs' experiences providing breastfeeding care for obese women during the prenatal, peripartum, and postpartum periods. Materials and Methods: In-depth, qualitative interviews were conducted with 34 HPs (including obstetricians, midwives, pediatricians, nurses, and lactation consultants) who care for pregnant or lactating women. They were recruited from a variety of settings in central New York. Interviews were audio-recorded, transcribed, verified for accuracy, and then analyzed qualitatively. Results: HPs identified obesity in multiple ways, some of which were consistent with standard cutoffs, whereas others implied extreme obesity. Nearly all HPs discussed ways they perceive obese women have challenges with breastfeeding. Some HPs described challenges as specific to obese women (e.g., limited mobility), whereas others described challenges as universal but more likely to occur among obese women (e.g., difficulties positioning the infant to breastfeed). Across professions, HPs described providing breastfeeding care for obese women as requiring more time and physical work and as being more challenging. HPs acknowledged stigma around obesity and discussed treating obese women with dignity and the same as other women. Strategies were suggested for improving breastfeeding support for obese women. Conclusions: HPs identified multiple challenges that obese women encounter with breastfeeding, as well as their own challenges with providing care. Comprehensive strategies are needed to assist obese women with breastfeeding and to alleviate strain on HPs who provide their care.

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Super obesity in pregnancy: difficulties in clinical management

Cited by 18 publications

References 57 publications

Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study

Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study

Adverse perinatal outcomes are more frequent in pregnancies with a low fetal fraction result on noninvasive prenatal testing

Health Professionals' Experiences Providing Breastfeeding-Related Care for Obese Women

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