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

ArticleinJournal of Maternal-Fetal and Neonatal Medicine 17(3):179-85 · April 2005with15 Reads
Impact Factor: 1.37 · 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.

    • "...ly increased risk of caesarean section of between 2-fold to more than 3-fold [13, 15, 18, 19,2122232425 , with the most common reason for caesarean section being delay during the first stage of labour,..."
      Delay in the first stage of labour is significantly more common17181920, with the risk ranging from 1.5 times to 3 times more likely. Obese women also have a significantly increased risk of caesarean section of between 2-fold to more than 3-fold [13, 15, 18, 19,2122232425 , with the most common reason for caesarean section being delay during the first stage of labour, even after augmentation with oxytocin171819. Caesarean section also carries additional risks for obese women and has a considerable impact on postnatal morbidity , with maternal obesity being an independent risk factor for post-caesarean infections [26].
    [Show abstract] [Hide abstract] ABSTRACT: Background Currently one-fifth of women in the UK are obese. Obese, pregnant woman are at an increased risk of experiencing complications of labour and serious morbidity. However, they are also more likely to undergo medical interventions such as induction of labour and caesarean section which in themselves confer additional health risks for obese women such as wound infection and deep vein thrombosis. Reducing unnecessary interventions and increasing normal birth rates for obese women would substantially improve their postnatal health and wellbeing and reduce the burden of NHS resources required to care for them post operatively. This research aimed to explore practitioners’ experiences of and strategies for providing intrapartum care to obese women. Method A qualitative methodology was adopted, focus groups and individual interviews were conducted with health professionals. Audio recordings were transcribed verbatim and data analysed using a framework approach. Results Twenty-four health professionals participated; Six Consultant Obstetricians two Consultant Anaesthetists and 16 midwives. Three key themes emerged from the data: medicalisation of obese birth; promotion of normal obese birth; and the complexities and contradictions in staff attitudes and behaviours. The overall interpretation is that positive approaches to obese birth offer opportunities to promote normal birth. However, many health professionals find the provision of intrapartum care to obese women challenging, and attitudes and behaviours towards the promotion of normal birth are heterogeneous, complex and contradictory. Conclusion The care of obese women during labour is generally medicalised and focussed on the associated risks. However, although there are conflicting views on how to care for obese women, some practitioners do strive to promote normality and optimise the potential for normal birth by challenging current practices and utilise some ‘interventions’ in order to facilitate normality and mobility during childbirth. Obesity is a major and growing health problem and a major cause of morbidity and mortality for pregnant women. It is essential that more positive proactive guidelines are available to maximise normal birth if the postnatal health of obese women is to be improved.
    Full-text · Article · Dec 2015 · BMC Pregnancy and Childbirth
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    • "...ted a two to three fold increase in the rate of caesarean among obese women with short stature [26,27] but a third study reporting interventions during labour in relation to height in obese women did no..."
      Although many studies have identified risk factors associated with caesarean for failure to progress in a general obstetric population of mixed BMI [25], and identified obesity as a risk factor, no studies have specifically investigated risk factors among overweight and obese women only. Two studies with populations of mixed BMI have performed subgroup analyses of obese women and reported a two to three fold increase in the rate of caesarean among obese women with short stature [26,27] but a third study reporting interventions during labour in relation to height in obese women did not support this association [28]. An association between induction of labour and caesarean delivery among nulliparous women of mixed BMI has previously been reported [29], particularly for labour arrest [30].
    [Show abstract] [Hide abstract] ABSTRACT: Maternal overweight and obesity are associated with slower labour progress and increased caesarean delivery for failure to progress. Obesity is also associated with hyperlipidaemia and cholesterol inhibits myometrial contractility in vitro. Our aim was, among overweight and obese nulliparous women, to investigate 1. the role of early pregnancy serum cholesterol and 2. clinical risk factors associated with first stage caesarean for failure to progress at term. Secondary data analysis from a prospective cohort of overweight/obese New Zealand and Australian nullipara recruited to the SCOPE study. Women who laboured at term and delivered vaginally (n=840) or required first stage caesarean for failure to progress (n=196) were included. Maternal characteristics and serum cholesterol at 14--16 weeks' of gestation were compared according to delivery mode in univariable and multivariable analyses (adjusted for BMI, maternal age and height, obstetric care type, induction of labour and gestation at delivery >=41 weeks). Total cholesterol at 14--16 weeks was not higher among women requiring first stage caesarean for failure to progress compared to those with vaginal delivery (5.55 +/- 0.92 versus 5.67 +/- 0.85 mmol/L, p= 0.10 respectively). Antenatal risk factors for first stage caesarean for failure to progress in overweight and obese women were BMI (adjusted odds ratio [aOR (95% CI)] 1.15 (1.07-1.22) per 5 unit increase, maternal age 1.37 (1.17-1.61) per 5 year increase, height 1.09 (1.06-1.12) per 1cm reduction), induction of labour 1.94 (1.38-2.73) and prolonged pregnancy >=41 weeks 1.64 (1.14-2.35). Elevated maternal cholesterol in early pregnancy is not a risk factor for first stage caesarean for failure to progress in overweight/obese women. Other clinically relevant risk factors identified are: increasing maternal BMI, increasing maternal age, induction of labour and prolonged pregnancy >=41 weeks' of gestation.
    Full-text · Article · Jul 2013 · BMC Pregnancy and Childbirth
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    • "... women with GDM have an increased risk of developing preeclampsia and delivery by Cesarean section [2,3] . For the infant, maternal GDM increases the risk of excessive adiposity, macrosomia (a birth wei..."
      GDM is associated with short term and long term morbidity for mother and baby. In the short term, women with GDM have an increased risk of developing preeclampsia and delivery by Cesarean section [2,3] . For the infant, maternal GDM increases the risk of excessive adiposity, macrosomia (a birth weight of >4000 g), shoulder dystocia , admittance to the neonatal intensive care unit and neonatal hypoglycemia [4,5].
    [Show abstract] [Hide abstract] ABSTRACT: Obesity is increasing in the child-bearing population as are the rates of gestational diabetes. Gestational diabetes is associated with higher rates of Cesarean Section for the mother and increased risks of macrosomia, higher body fat mass, respiratory distress and hypoglycemia for the infant. Prevention of gestational diabetes through life style intervention has proven to be difficult. A Finnish study showed that ingestion of specific probiotics altered the composition of the gut microbiome and thereby metabolism from early gestation and decreased rates of gestational diabetes in normal weight women. In SPRING (the Study of Probiotics IN the prevention of Gestational diabetes), the effectiveness of probiotics ingestion for the prevention of gestational diabetes will be assessed in overweight and obese women. SPRING is a multi-center, prospective, double-blind randomized controlled trial run at two tertiary maternity hospitals in Brisbane, Australia. Five hundred and forty (540) women with a BMI > 25.0 kg/m2 will be recruited over 2 years and receive either probiotics or placebo capsules from 16 weeks gestation until delivery. The probiotics capsules contain > 1x109 cfu each of Lactobacillus rhamnosus GG and Bifidobacterium lactis BB-12 per capsule. The primary outcome is diagnosis of gestational diabetes at 28 weeks gestation. Secondary outcomes include rates of other pregnancy complications, gestational weight gain, mode of delivery, change in gut microbiome, preterm birth, macrosomia, and infant body composition. The trial has 80% power at a 5% 2-sided significance level to detect a >50% change in the rates of gestational diabetes in this high-risk group of pregnant women. SPRING will show if probiotics can be used as an easily implementable method of preventing gestational diabetes in the high-risk group of overweight and obese pregnant women.
    Full-text · Article · Feb 2013 · BMC Pregnancy and Childbirth
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