Article

Maternal superobesity and perinatal outcomes

Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
American journal of obstetrics and gynecology (Impact Factor: 3.97). 05/2012; 206(5):417.e1-6. DOI: 10.1016/j.ajog.2012.02.037
Source: PubMed

ABSTRACT The purpose of this study was to determine the effect of maternal superobesity (body mass index [BMI], ≥ 50 kg/m(2)) compared with morbid obesity (BMI, 40-49.9 kg/m(2)) or obesity (BMI, 30-39.9 kg/m(2)) on perinatal outcomes.
We conducted a retrospective cohort study of birth records that were linked to hospital discharge data for all liveborn singleton term infants who were born to obese Missouri residents from 2000-2006. We excluded major congenital anomalies and women with diabetes mellitus or chronic hypertension.
There were 64,272 births that met the study criteria, which included 1185 superobese mothers (1.8%). Superobese women were significantly more likely than obese women to have preeclampsia (adjusted relative risk [aRR], 1.7; 95% confidence interval [CI], 1.4-2.1), macrosomia (aRR, 1.8; 95% CI, 1.3-2.5), and cesarean delivery (aRR, 1.8; 95% CI, 1.5-2.1). Almost one-half of all superobese women (49.1%) delivered by cesarean section, and 33.8% of superobese nulliparous women underwent scheduled primary cesarean delivery.
Women with a BMI of ≥ 50 kg/m(2) are at significantly increased risk for perinatal complications compared with obese women with a lower BMI.

0 Bookmarks
 · 
162 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Obesity is increasing worldwide, especially in the USA. This is reflected in the pregnant population, with up to a third of women classified as obese during their pregnancy. It poses a challenge to the practitioners throughout pregnancy, labor and delivery, as well as in postpartum care. Obesity is also a risk factor for multiple pregnancy complications including gestational diabetes, hypertensive disorders of pregnancy, iatrogenic preterm birth, fetal macrosomia and intrauterine fetal demise. Antenatal care challenges, including limitation of fetal ultrasound evaluation, contribute to a greater number of undetected anomalies and poor fetal weight estimation. Maternal risks such as increased rates of cesarean section, and subsequent postoperative complications such as wound infection and venous thromboembolic events, are increasing in prevalence. Optimal prenatal care requires knowledge of and attention to each of these risks and appropriate patient counseling.
    Expert Review of Obstetrics &amp Gynecology 01/2014; 7(6). DOI:10.1586/eog.12.53
  • [Show abstract] [Hide abstract]
    ABSTRACT: We describe characteristics and risk factors regarding pregnancy outcome in women with a preconception body mass index (BMI) >50 kg/m2 compared with women with BMI ≤50 kg/m2 in a retrospective population cohort study in singleton pregnancies from the Danish Medical Birth Registry. Results were analyzed as relative risks by a two-proportion z-test. Women with preconception BMI >50 kg/m2 smoked, developed gestational diabetes and pre-eclampsia, and needed induction of labor more frequently than mothers with BMI ≤50 kg/m2. Examination of the case records showed that many attempted vaginal delivery without epidural analgesia, 21% needed an emergency cesarean section (compared with 12% among women with BMI ≤50 kg/m2), and 25% underwent general anesthesia in this context. Many neonates were macrosomic and 34% needed neonatal intensive care and early feeding compared with 6% of neonates from women with BMI ≤50 kg/m2. Women with an extremely high preconception BMI develop more pregnancy complications and their neonates appear affected by this as well.
    Acta Obstetricia Et Gynecologica Scandinavica 09/2013; 92(9). DOI:10.1111/aogs.12174 · 1.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A recent trend in increasing rates of severe maternal morbidity and mortality despite quality improvements has been noted. The goal of this study is to estimate the national prevalence of obstructive sleep apnea (OSA) in pregnant women and examine associations between OSA and pregnancy-related morbidities, including in-hospital maternal mortality. A retrospective, cross-sectional analysis. A nationally representative sample of maternal hospital discharges from 1998-2009. The analytic sample included 55,781,965 pregnancy-related inpatient hospital discharges. N/A. The Nationwide Inpatient Sample (NIS) database was used to identify hospital stays for women who were pregnant or gave birth. Among these women, we determined length of hospital stay, in-hospital mortality, and used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to identify OSA and other outcome measures. Multivariable logistic regression modeling was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the associations between OSA and each outcome. The overall rate of OSA was 3.0 per 10,000; however, the rate climbed substantially from 0.7 in 1998 to 7.3 in 2009, with an average annual increase of 24%. After controlling for obesity and other potential confounders, OSA was associated with increased odds of pregnancy-related morbidities including preeclampsia (OR, 2.5; 95% CI, 2.2-2.9), eclampsia (OR, 5.4; 95% CI, 3.3-8.9), cardiomyopathy (OR, 9.0; 95% CI, 7.5-10.9), and pulmonary embolism (OR, 4.5; 95% CI, 2.3-8.9). Women with OSA experienced a more than fivefold increased odds of in-hospital mortality (95% CI, 2.4-11.5). The adverse effects of OSA on selected outcomes were exacerbated by obesity. Obstructive sleep apnea is associated with severe maternal morbidity, cardiovascular morbidity, and in-hospital death. Targeted interventions may improve pregnancy outcomes in this group. Louis JM, Mogos MF, Salemi JL, Redline S, Salihu HM. Obstructive sleep apnea and severe maternal-infant morbidity/mortality in the United States, 1998-2009. SLEEP 2014;37(5):843-849.
    Sleep 05/2014; 37(5):843-849. DOI:10.5665/sleep.3644 · 5.06 Impact Factor

Full-text (2 Sources)

Download
39 Downloads
Available from
May 31, 2014