Changes in prepregnancy body mass index between pregnancies and risk of primary cesarean delivery
ABSTRACT The objective of the study was to examine whether the risk and indications for primary cesarean in the second pregnancy are influenced by changes in prepregnancy body mass index (BMI) between pregnancies.
We performed a cohort analysis using the Missouri maternally linked birth and infant death surveillance datasets (1989-1997), comprised of women with their first 2 consecutive live births (n = 113,789). BMI (kilograms per square meter) was categorized as underweight (less than 18.5 kg/m2), normal (18.5 to 24.9 kg/m2), overweight (25 to 29.9 kg/m2), and obese (30 kg/m2 or greater). Indications for primary cesarean were categorized as breech, dystocia, fetal distress, and others. Timing of primary cesarean was categorized as elective (prior to labor) and emergent (after initiation of labor). Adjusted odds ratio (OR) was used to quantify the associations between changes in prepregnancy BMI and indications for primary cesarean.
The rate of primary cesarean in the second pregnancy was 9.2%. Compared with women with normal BMI in their first 2 pregnancies, women who increased their BMI between pregnancies had increased risk of primary cesarean for all indications. Women who remained obese or overweight in both pregnancies were at increased risk of primary cesarean following breech (OR 1.28 and 1.13, respectively); dystocia (OR 1.94 and 1.41, respectively); fetal distress (OR 1.43 and 1.26, respectively); others (OR 3.17 and 1.63, respectively); and elective (OR 2.31 and 1.43, respectively) and emergent (OR 1.66 and 1.30, respectively) cesarean section. Women who lowered their BMI from obese to overweight or overweight to normal between pregnancies had risks of primary cesarean comparable with those with normal BMI in both pregnancies. Any increase in BMI from underweight to overweight or obese between the first 2 pregnancies was associated with increased risk of primary cesarean (OR 1.20 to 3.04) in the second pregnancy.
Increases in prepregnancy BMI between first 2 pregnancies from normal to obese is associated with increased risk of indications for primary cesarean. The association between being overweight or obese or increases in prepregnancy BMI between pregnancies and primary cesarean in the second pregnancy suggests that counseling women with regard to their high BMI may be beneficial.
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ABSTRACT: Disparities in cesarean rates in the United States represent an important social problem because cesareans are related to maternal deaths and to the high cost of American health care. There are pervasive racial-ethnic and socioeconomic disparities in maternity care as in health care more generally, yet there has been little scrutiny of how overuse of cesarean deliveries might be linked to these disparities. There are at least two possibilities when it comes to c-sections: black, Hispanic, Native American, and low socioeconomic status (SES) mothers could be less likely to have needed cesareans, leading to more negative outcomes for both mothers and babies, or they could be more likely to have medically unnecessary cesareans, leading to more negative outcomes as a result of the surgery itself. This research uses data on all recorded births in the United States in 2006 to analyze differences in the odds of a cesarean delivery by race-ethnicity and SES. The analysis reveals that non-Hispanic black, Hispanic/Latina, and Native American mothers are more likely to have cesarean deliveries than non-Hispanic white or Asian mothers. Also, after accounting for medical indications, increasing education is associated with a decline in odds of a cesarean delivery, especially for non-Hispanic whites. The results suggest that high cesarean rates are an indicator of low-quality maternity care, and that women with racial and socioeconomic advantages use them to avoid medically unnecessary cesarean deliveries rather than to request them.Social Problems 05/2012; 59(2):207-227. DOI:10.1525/sp.2012.59.2.207 · 1.23 Impact Factor
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ABSTRACT: The aim of this study was to analyse perinatal complications in woman with increased BMI at pregnancy term. Study included 23190 women who gave singleton birth during a 10-year period in our institution. Maternal databases were reviewed for pregnancy, labor and delivery complications and early maternal postpartum morbidity. Women with increased BMI at pregnancy term had a significantly higer incidence of postterm pregnancy, gestational diabetes, pregnancy-induced hypertension and third trimester hemorrhage, compared to normal weight women (p 0.000). Women with increased BMI had significantly more labor induction with prostaglandins (p 0.001 and 0.000) and elective caesarean (p 0.025 and 0.000). Also, overweight and obese women had higher incidence of operative delivery: caesarean section (p 0.000) and vacuum extraction (p 0.000). The incidences of postpartum febrility (p 0.057, 0.000, 0.002) and trombophlebits (p 0.013) were also significantly higher. We can conclude that prepregnancy normal weight women with increased BMI during pregnancy need special follow-up and counseling in pregnancy and delivery.Central European Journal of Medicine 03/2009; 4(1):71-75. DOI:10.2478/s11536-009-0001-1 · 0.21 Impact Factor
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ABSTRACT: To examine the association between interpregnancy weight change and the risk for adverse maternal and neonatal outcomes. All live-born singleton births delivered at 21-42 weeks of gestation in women who had their first two consecutive births between 2009 and 2011 in Flanders (the northern part of Belgium) and who were included in the Study Center for Perinatal Epidemiology database (N=7,897) were included. Interpregnancy weight change was calculated as the difference between the prepregnancy body mass index (BMI) of the first pregnancy and the prepregnancy BMI of the second pregnancy. Multivariate logistic regression analysis to predict gestational diabetes mellitus, pregnancy-induced hypertension, cesarean delivery, macrosomia (4,000 g or greater), low birth weight (less than 2,500 g), and congenital malformations were performed. The adjusted odds ratio (OR) for gestational diabetes mellitus was 2.25 (95% confidence interval [CI] 1.33-3.78; P=.002) for interpregnancy weight retention of 2 or more BMI units, and the adjusted OR for pregnancy-induced hypertension was 3.76 (95% CI 2.16-6.57; P<.001) with an increase of 3 or more BMI units between pregnancies, but these associations were only present in underweight and normal-weight women. In overweight and obese women, the adjusted OR was 2.04 (95% CI 1.41-2.95; P<.001) for cesarean delivery for an interpregnancy weight retention of 2 or more BMI units. In underweight and normal-weight women, the risk for macrosomia was halved if women lost more than 1 BMI unit between pregnancies, but at the same time, the risk for low birth weight doubled. We show that weight retention between the first and second pregnancy is associated with an increased risk for perinatal complications, even in underweight and normal-weight women. Stabilizing interpregnancy weight appears an important target for reducing adverse perinatal outcomes in a second pregnancy. LEVEL OF EVIDENCE:: II.Obstetrics and Gynecology 10/2013; DOI:10.1097/AOG.0b013e3182a7f63e · 4.37 Impact Factor