Maternal pre-pregnancy overweight status and obesity as risk factors for cesarean delivery

University of Washington Seattle, Seattle, Washington, United States
Journal of Maternal-Fetal and Neonatal Medicine (Impact Factor: 1.21). 04/2005; 17(3):179-85. DOI: 10.1080/14767050500073456
Source: PubMed

ABSTRACT To determine the extent to which, if at all, maternal pre-pregnancy adiposity and other anthropometric factors are related to risk of cesarean delivery.
This hospital-based prospective cohort study included 738 nulliparous women who initiated prenatal care prior to 16 weeks gestation. Participants provided information about their pre-pregnancy weight and height and other sociodemographic and reproductive covariates. Labor and delivery characteristics were obtained from maternal and infant medical records. Risk ratios (RR) and 95% CI were estimated by fitting generalized linear models.
The proportion of cesarean deliveries in this population was 26%. Women who were overweight (BMI 25.00-29.99 kg/m2) were twice as likely to deliver their infants by cesarean section as lean women (BMI<20.00 kg/m2) (RR=2.09; 95% CI 1.27-3.42). Obese women (BMI>or=30.00 kg/m2) experienced a three-fold increase in risk of cesarean delivery when compared with this referent group (RR=3.05; 95% CI 1.80-5.18). The joint association between maternal pre-pregnancy overweight status and short stature was additive. When compared with tall (height>or=1.63 m), lean women, short (<1.63 m), overweight (BMI>or=25.00 kg/m2) women were nearly three times as likely to have a cesarean delivery (RR=2.79; 95% CI 1.72-4.52).
Our findings suggest that nulliparous women who are overweight or obese prior to pregnancy, and particularly those who are also short, have an increased risk of delivering their infants by cesarean section.

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    • "Furthermore, obesity is becoming an increasingly common problem, both in general population and in women of the reproductive age (Catalano, 2007). There is a growing body of evidence suggesting that obese pregnant women are at greater risk of a number of maternal and fetal complications of pregnancy, including pre-eclampsia, ceasarean section intrauterine death (Cedergren, 2004; Dempsey et al., 2005), induction of labor, and anesthetic complications (Robinson et al., 2005). Heslehurts et al. (2007) conducted a systematic review to ascertain the impact of BMI on pregnancy outcomes. "
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    ABSTRACT: Body mass index (BMI) is widely used to categorize the degree of obesity and to guide recommendations for weight gain during pregnancy. To examine the relationship between the maternal body mass index of nulliparous women and the route of delivery in a sample of Iranian Kurdish women, a cross sectional descriptive study was conducted, at Beasat Hospital in Sanandaj, the capital of Kurdistan province, West of Iran. The study sample consisted of 980 nulliparous women with spontaneous labor. Results showed that there is a significant association between cesarean section and higher maternal BMI. The cesarean section rate rose from 30% in women with normal BMI to 56% in the women with BMI≥35. Overweight women should be given information about risk of cesarean section before conception and be encouraged to reduce their weight.
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    • "The association of hypertensive complications with maternal BMI is supported by recent literature [Doherty et al. 2006], whereas to our knowledge the association of peripheral edema with maternal BMI has not yet been reported. With respect to fetal outcome we found higher maternal BMI to be associated with higher incidence of caesarean section, which is in line with several recent studies [Barau et al. 2006; Abenhaim et al. 2007; Stepan et al. 2006; Cedergren 2006; Dempsey et al. 2005], whereas there was no impact of maternal BMI on fetal presentation. Thus we suggest the higher incidence of caesarean section in overweight/obese mothers to be most likely due to fetal macrosomia, which was found to be likewise associated with increased maternal BMI in our study as well as in the literature [Usha Kiran et al. 2005; Clausen et al. 2005]. "
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    ABSTRACT: Maternal body mass index has an impact on maternal and fetal pregnancy outcome. An increased maternal BMI is known to be associated with admission of the newborn to a neonatal care unit. The reasons and impact of this admission on fetal outcome, however, are unknown so far. The aim of our study was to investigate the impact of maternal BMI on maternal and fetal pregnancy outcome with special focus on the children admitted to a neonatal care unit. A cohort of 2049 non-diabetic mothers giving birth in the Charite university hospital was prospectively studied. The impact of maternal BMI on maternal and fetal outcome parameters was tested using multivariate regression analysis. Outcome of children admitted to a neonatal ward (n = 505) was analysed. Increased maternal BMI was associated with an increased risk for hypertensive complications, peripheral edema, caesarean section, fetal macrosomia and admission of the newborn to a neonatal care unit, whereas decreased BMI was associated with preterm birth and lower birthweight. In the neonatal ward children from obese mothers are characterized by hypoglycaemia. They need less oxygen, and exhibit a shorter stay on the neonatal ward compared to children from normal weight mothers, whereas children from underweight mothers are characterized by lower umbilical blood pH and increased incidence of death corresponding to increased prevalence of preterm birth. Pregnancy outcome is worst in babies from mothers with low body mass index as compared to healthy weight mothers with respect to increased incidence of preterm birth, lower birth weight and increased neonate mortality on the neonatal ward. We demonstrate that the increased risk for neonatal admission in children from obese mothers does not necessarily indicate severe fetal impairment.
    European journal of medical research 06/2009; 14(5):216-22. DOI:10.1186/2047-783X-14-5-216 · 1.40 Impact Factor
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    • "Cesarean births are performed more frequently when women are overweight or obese ( Cedergren, 2004; Ehrenberg, Durnwald, Catalano, & Mercer, 2004; Jensen et al., 2003 ). Dempsey et al. (2005) reported that overweight women (BMI > 25) were two times more likely to give birth by cesarean delivery and obese women (BMI > 30) were three times more likely than their normal-weight counterparts. When parity is considered, Weiss et al. (2004) reported a cesarean delivery rate of 20.7% for a nulliparous control group (BMI < 30), a rate of 33.8% for obese nulliparas, and a rate of 47.4% for morbidly obese nulliparas. "
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    ABSTRACT: Women who are overweight or obese during their childbearing years are at an increased risk for pregnancy-induced hypertension, gestational diabetes, labor induction, cesarean births, and failed vaginal birth after cesarean. During the postpartum, they experience increased rates of puerperal infection and decreased rates of breastfeeding initiation or continuation. Their infants are at higher risk for having congenital anomalies or being stillborn. Nurses can use this knowledge to adapt the care they provide and to encourage health-promoting behaviors.
    Journal of Obstetric Gynecologic & Neonatal Nursing 09/2007; 36(5):482-9. DOI:10.1111/j.1552-6909.2007.00182.x · 1.20 Impact Factor
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