Obesity, obstetric complications and cesarean delivery rate - A population-based screening study

Mid-Columbia Medical Center, DLS, Oregon, United States
American Journal of Obstetrics and Gynecology (Impact Factor: 4.7). 05/2004; 190(4):1091-7. DOI: 10.1016/j.ajog.2003.09.058
Source: PubMed

ABSTRACT This study was undertaken to determine whether obesity is associated with obstetric complications and cesarean delivery.
A large prospective multicenter database was studied. Subjects were divided into 3 groups: body mass index (BMI) less than 30 (control), 30 to 34.9 (obese), and 35 or greater (morbidly obese). Groups were compared by using univariate and multivariable logistic regression analyses.
The study included 16,102 patients: 3,752 control, 1,473 obese, and 877 morbidly obese patients. Obesity and morbid obesity had a statistically significant association with gestational hypertension (odds ratios [ORs] 2.5 and 3.2), preeclampsia (ORs 1.6 and 3.3), gestational diabetes (ORs 2.6 and 4.0), and fetal birth weight greater than 4000 g (ORs 1.7 and 1.9) and greater than 4500 g (ORs 2.0 and 2.4). For nulliparous patients, the cesarean delivery rate was 20.7% for the control group, 33.8% for obese, and 47.4% for morbidly obese patients.
Obesity is an independent risk factor for adverse obstetric outcome and is significantly associated with an increased cesarean delivery rate.

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    • "There is a close relationship between HDP and pre-pregnancy BMI, including the increased risk of HDP in women with obesity during pregnancy [19], [27]–[29]. Some studies suggest that each increase of 5 to 7 kg/m2 in BMI doubles the risk of developing preeclampsia [30]–[31]. Obese women were at a higher risk of preeclampsia compared to those with a normal BMI [32]. Our work confirms the association of body weight with risk of HDP: obese women had the highest risk of HDP (Table 1 and Table S3 in File S1). "
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    ABSTRACT: Hypertensive disorders of pregnancy (HDP) are a group of medical complications in pregnancy and also a risk factor for severe pregnancy outcomes, but it lacks a large-scale epidemiological investigation in recent years. This survey represents a multicenter cross-sectional retrospective study to estimate the prevalence and analyze the risk factors for HDP among the pregnant women who had referred for delivery between January 1st 2011 and December 31st 2011 in China Mainland. A total of 112,386 pregnant women were investigated from 38 secondary and tertiary specialized or general hospitals randomly selected across the country, of which 5,869 had HDP, accounting for 5.22% of all pregnancies. There were significant differences in the prevalence of HDP between geographical regions, in which the North China showed the highest (7.44%) and Central China showed the lowest (1.23%). Of six subtypes of HDP, severe preeclampsia accounted for 39.96%, gestational hypertension for 31.40%, mild preeclampsia for 15.13%, chronic hypertension in pregnancy for 6.00%, preeclampsia superimposed on chronic hypertension for 3.68% and eclampsia for 0.89%. A number of risk factors for HDP were identified, including twin pregnancy, age of >35 years, overweight and obesity, primipara, history of hypertension as well as family history of hypertension and diabetes. The prevalence of pre-term birth, placental abruption and postpartum hemorrhage were significantly higher in women with HDP than those without HDP. The possible risk factors confirmed in this study may be useful for the development of early diagnosis and appropriate treatment of HDP.
    PLoS ONE 06/2014; 9(6):e100180. DOI:10.1371/journal.pone.0100180 · 3.23 Impact Factor
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    • "In the United States, 76% of Hispanic women are considered overweight and 43% obese (Flegal, Carroll, Ogden, & Curtin, 2010). Women who are obese during pregnancy are at increased risk for cesarean section with subsequent complications (Weiss et al., 2004). Also, an obese parent increases the risk that her child will be obese by 50% (American Academy of Child and Adolescent Psychiatry, 2011). "
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    ABSTRACT: As a first step in a proposed program of community-based participatory research, this study investigated access to care and specific health needs in a population of Hispanic women from a medically underserved, urban community. There were 66 Hispanic women recruited at a local church to complete a 94-item researcher-developed survey. Thirty-two percent of women in the study were not U.S. citizens. Being insured, being a citizen, and having a medical diagnosis were significant in satisfaction with care. The most prevalent health issue for this population was being overweight or obese. This study demonstrates the use of the community needs assessment process in the development of interventions to improve a community's health and health care. This is especially true in the Hispanic community in which large variations based on culture and country of origin will impact the success of planned interventions.
    Hispanic Health Care International 06/2014; 12(2). DOI:10.1891/1540-4153.12.2.71
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    • "The combination of obesity and pregnancy increases the risk for additional complications of gestational diabetes, hypertension , cesarean deliveries with their infectious complications, birth defects, and stillbirth (Chu et al., 2007; Gunatilake & Perlow, 2011; Kominiarek, Vanveldhuisen, et al., 2010; Myles, Gooch, & Santolaya, 2002; Stothard, Tennant, Bell, & Rankin, 2009; Weiss et al., 2004) One approach to addressing obesity during pregnancy is to improve health behaviors (e.g., smoking, physical activity, and nutrition) to meet gestational weight gain recommendations and improve other perinatal outcomes. Pregnancy is often viewed as the ultimate motivator to improve health behaviors with the goal of having a healthy pregnancy and infant. "
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    ABSTRACT: Background An effective behavioral intervention for gestational weight gain in minority obese women needs to incorporate their baseline health behaviors and nutrition patterns. The objective of this study was to compare racial/ethnic differences in health behaviors and nutrition in pregnant obese and non-obese minorities. Methods A face-to-face, 75-item survey was administered to 94 women (46% non-obese, 54% obese; 71% Black, 29% Hispanic) at a prenatal visit to an inner-city clinic. Television watching, exercise, and nutrition were compared between obese and non-obese women and racial/ethnic differences were compared within each body mass index (BMI) category using chi-square and Fisher's exact tests. Interactions between BMI category and race/ethnicity for each health behavior were examined. Findings More obese women described their nutrition as “fair” or “poor” (36% vs. 15%; p = .02) and missed more meals per day (21% vs. 6%; p = .03) compared with non-obese women. Obese Blacks were less likely to improve their nutrition during pregnancy compared with obese Hispanics (28% vs. 58%; p = .08). Non-obese Blacks watched more television (p = .03) and exercised less during pregnancy (p = .04) than non-obese Hispanics. Except for dairy products, there were no differences in daily nutrition (fruit, soda, vegetables, chips) among the BMI categories and racial/ethnic groups; however, fewer than 50% of all participants consumed fruits and vegetables every day. There was an interaction between BMI category and race/ethnicity: Obese Hispanics exercised less before pregnancy (p = .02), but exercised more during pregnancy (p = .01) compared with non-obese Hispanics. Conclusions Interventions for gestational weight gain in obese women may have greater success if they considered racial/ethnic differences in health behaviors, especially related to exercise.
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