Effect of Maternal Obesity on the Risk of Fetal Loss After Amniocentesis and Chorionic Villus Sampling
ABSTRACT To estimate the risk of fetal loss in obese women undergoing amniocentesis and chorionic villus sampling (CVS).
This was a retrospective cohort study of all women undergoing amniocentesis or CVS. The primary outcome was any fetal loss before 24 weeks of gestation. A secondary analysis was performed examining pregnancy loss within 14 days of the procedure, excluding termination of pregnancy. Obese (body mass index [BMI] 30.0 or higher) and nonobese (BMI lower than 30.0) patients were compared, and the postprocedure loss rate was also estimated by BMI strata. Obese and nonobese patients were compared with univariable and bivariate statistics; multivariable logistic regression models were developed to estimate the effect of maternal obesity.
Between obese (n=2,742) and nonobese (n=8,037) women undergoing amniocentesis, no difference existed in the risk of fetal loss before 24 weeks of gestation (4.7% [combined background and procedure loss] compared with 4.2%, adjusted odds ratio [OR] 1.1, 95% confidence interval [CI] 0.8-1.5). For women undergoing CVS, no difference in the risk of pregnancy loss was seen between obese (n=855) and nonobese (n=4,125) women (6.4% compared with 6.3%, adjusted OR 1.0, 95% CI 0.7-1.3). Compared with women not undergoing a procedure, the attributable risk for obese women was 0.3% (95% CI -0.2 to 0.9) amniocentesis and 0.1% (95% CI -0.1 to 0.2) CVS. The difference in fetal loss between the BMI 40.0 or higher and BMI lower than 25.0 groups after amniocentesis was significant after adjusting for maternal age (adjusted OR 2.2, 95% CI 1.2-3.9). This study had greater than 90% power to detect a 50% increase in the risk of pregnancy loss after amniocentesis and CVS (with an α error of 0.05).
A BMI of 30.0-40.0 does not increase the risk for fetal loss after invasive prenatal diagnostic procedures. A higher loss rates with class III obesity (BMI 40.0 or higher) was observed for amniocentesis procedures.
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ABSTRACT: Fetal takings still concern about 6 to 7% of the pregnancies. If, in the majority of the cases, the taking does not present difficulty for a trained operator, particular circumstances related to maternal context (anticoagulating treatment, vaginal bleeding, fever. . .) may make the taking become more difficult. From a questionnaire sent to the French multidisciplinary centers for prenatal diagnosis and a review of the literature, we establish guidelines for fetal taking in these circumstances. (c) 2013 Elsevier Masson SAS. All rights reserved.Gynécologie Obstétrique & Fertilité 07/2013; 41(7-8). DOI:10.1016/j.gyobfe.2013.06.007 · 0.52 Impact Factor
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ABSTRACT: Obesity is a worldwide epidemic and can have a profound effect on pregnancy risks. Obese patients tend to be older and are at increased risk for structural fetal anomalies and aneuploidy, making screening options critically important for these women. Failure rates for first-trimester nuchal translucency (NT) screening increase with obesity, while the ability to detect soft-markers declines, limiting ultrasound-based screening options. Obesity also decreases the chances of completing the anatomy survey and increases the residual risk of undetected anomalies. Additionally, non-invasive prenatal testing (NIPT) is less likely to provide an informative result in obese patients. Understanding the limitations and diagnostic accuracy of aneuploidy and anomaly screening in obese patients can help guide clinicians in counseling patients on the screening options.Journal of Clinical Medicine 08/2015; 3(3):795-808. DOI:10.3390/jcm3030795