Maternal pre-pregnancy overweight status and obesity as risk factor for cesarean delivery
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.
Available from: Lesley Mccowan
- "Although many studies have identified risk factors associated with caesarean for failure to progress in a general obstetric population of mixed BMI , 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 . An association between induction of labour and caesarean delivery among nulliparous women of mixed BMI has previously been reported , particularly for labour arrest . "
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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.
Available from: Marloes Dekker Nitert
- "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]. "
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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.
Available from: Roonak Shahoei
- "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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