OBSTETRICSThe Impact of Increasing Obesity Class on Obstetrical Outcomes
Section snippets
INTRODUCTION
Rates of obesity, including an increased prevalence of morbid obesity (BMI > 35), are rising dramatically in developed countries.1., 2., 3., 4. This trend has led to a concurrent increase in health concerns for women of reproductive age,1,4 and it is now well established that weight gain and obesity cause major comorbidities in pregnancy that contribute to adverse maternal and neonatal outcomes.5,6
In pregnant women, obesity has been shown to increase the likelihood of gestational diabetes,7
MATERIALS AND METHODS
We collected data retrospectively from mothers who gave birth to one infant between December 1, 2007, and March 31, 2010, at a tertiary care centre in south-eastern Ontario. Only mothers with a known pre-pregnancy BMI (or height and pre-pregnancy weight) who delivered at > 20 weeks’ gestation were included in the study. Underweight mothers (BMI < 18.5) were excluded from the sample. All participants had their infants delivered by an on-call family physician or obstetrician.
Data for this study
RESULTS
A total of 6674 records with complete pre-pregnancy BMI information were identified from the database. The sample included 3698 (55.4%) women with normal BMI, 1648(24.7%) overweight women, 786 (11.8%) women in obese class I, 288 (4.3%) women in obese class II, and 254 (3.8%) women in obese class III. Maternal characteristics are shown in Table 1. Statistically significant differences were noted between BMI groups for rates of pre-gestational diabetes, hypertension, and asthma, with the highest
DISCUSSION
The results of this retrospective cohort study demonstrated that women with overweight or obese BMI had a higher rate of pre-existing morbidities such as diabetes and chronic hypertension that affected their pregnancy and delivery outcomes negatively. Maternal overweight and obesity were linearly associated with higher rates of preeclampsia and gestational diabetes. Gestational hypertension also increased significantly with increasing BMI category, although the highest rate was observed in
ACKNOWLEDGEMENTS
The authors acknowledge the support provided by Dr Ann Sprague from BORN Ontario. The authors would also like to acknowledge the contributions to data entry and literature review to this project by Linda McCabe, Liam Faught, and Karine Tawagi.
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2020, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :In recent years, the appropriateness of the use of the Friedman curve for current parturients has been debated because it was created on the basis of a small, homogenous population of younger women with a lower average BMI and infant birth weight than is found in the modern obstetrical population.7–10 Several studies, including the assessment of 118 978 singleton pregnancies in the United States, have demonstrated that the first stage of labour progresses significantly more slowly as BMI increases in both nulliparous and multiparous women.11–13 However, these studies do not indicate whether the cesarean section rates in pregnant women with obesity are modifiable.
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The preliminary results of this study were presented at the Society of Maternal Fetal Medicine’s 30th Annual Scientific Meeting in Chicago, Illinois on February 5, 2010.
The final results of this study were presented at the Annual Clinical Meeting of The Society of Obstetricians and Gynaecologists of Canada in Vancouver, British Columbia, June 21-25, 2011.
Competing Interests: None declared