Changes in prepregnancy body mass index between pregnancies and risk of primary cesarean delivery

University of Alabama at Birmingham, Birmingham, Alabama, United States
American journal of obstetrics and gynecology (Impact Factor: 4.7). 11/2007; 197(4):376.e1-7. DOI: 10.1016/j.ajog.2007.06.015
Source: PubMed


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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    • "The index ranges from 1 (inadequate) to 4 (adequate+). Both maternal age and obesity are associated with higher rates of pregnancy-related risks, such as diabetes and hypertension, and lead to a higher probability of cesarean delivery (Dulitzki et al. 1998; Ecker et al. 2001; Getahun et al. 2007; Peipert and Bracken 1993; Porreco and Thorp 1996; Rosenberg et al. 2003). We measure maternal age in years. "
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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.
    Full-text · Article · May 2012 · Social Problems
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    • "Researchers believe that because in pre-pregnancy cares, weight balance and proper diet are taught to mothers, and specific reviews are done for identifying and eliminating the risk factors, the prevalence of some complications such as preterm delivery,8 neonatal macrosomia,20 and other cesarean indications will be reduced. The reduction in risk factors and treating underlying diseases will improve pregnancy outcomes.1221 "
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    ABSTRACT: Pre-pregnancy care is considered as the services assessing and reducing the pregnancy risks through providing medical care and mental support. Therefore, a pre-pregnancy counseling protocol was prepared based on a series of guidelines. This study aimed to determine the effect of the protocol on pregnancy and labor indices. This was a four-phase field study conducted in four randomly selected urban and rural health centers in Shahreza. In the first phase, the information including pregnancy and labor indices was extracted. The participants were all the women who had a delivery in the year before the study (census). In the second and third phases (3 and 6 months after implementing the protocol in the case centers), the process of implementing the protocol was assessed. In the fourth phase (a year later), pregnancy and labor indices were determined in case and control centers (on all the women who had labor in the year before) again and the results were compared in case and control groups as well as before and after implementing the protocol. Data was collected by reviewing documentations and using data collection forms. It was then analyzed by descriptive and analytical statistics using SPSS RESULTS: The obtained results indicated the positive effects of pre-pregnancy cares on cesarean indices, percentage of underlying diseases, pregnancy over the age of 35, and pregnancy intervals of less than 3 years. In addition, the protocol had been implemented correctly in 8.2% of the cases in the second phase, and in 30.2% of the cases in the third phase. The positive effects of pre-pregnancy cares on some of the indices raised the necessity of seriously considering and integrating this program in the routine women's health care programs. Considering that less than one-third of the staff members of the case centers had completely conducted the pre-pregnancy cares, monitoring the staff's performance is essential for improving the effectiveness of the care.
    Full-text · Article · Mar 2011 · Iranian journal of nursing and midwifery research
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    • "It is a fact that obesity before pregnancy, defined as increased prepregnancy BMI, was connected with increased frequency of pregnancy, labor and puerperal complications. Increases in prepregnancy BMI between the first two pregnancies from normal to obese are associated with increased risk of indications for primary cesarean [19]. Some authors showed different observations. "
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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.
    Full-text · Article · Mar 2009 · Central European Journal of Medicine
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