52: Maternal obesity without hypertension and diabetes-is the neonate at risk?

Abstract

Maternal obesity is associated with adverse neonatal outcomes. However, these adverse neonatal outcomes are largely attributed in the literature to obesity-related co-morbidities such as hypertension (HTN) and diabetes (DM). We investigated the independent risk of maternal obesity for neonatal morbidity in the absence of HTN or DM. This is a secondary analysis of a prospective cohort study of singleton deliveries from 2010-2014 at 37 weeks or beyond. Women with gestational/pre-gestational DM and hypertensive disorders including chronic HTN, gestational HTN, and pre-eclampsia were excluded. The primary outcomes were two: 1) a composite of neonatal morbidity (death, therapeutic hypothermia, mechanical ventilation, respiratory distress, meconium aspiration, seizures, or suspected sepsis) and 2) a composite of neonatal neurologic morbidity (hypoxic ischemic encephalopathy, therapeutic hypothermia, or seizures). The primary outcomes were compared between patients with and without obesity (BMI ≥ 30 kg/m2). Adjusted odds ratios were estimated using multivariable logistic regression. Of 6516 women without additional comorbidities, 3352 (51%) were obese. 538 (8%) neonates had composite morbidity, and 33 (0.5%) neonates had composite neurologic morbidity. After adjusting for race and mode of delivery, obese patients had significantly increased odds of composite neonatal morbidity (9.3% vs 7.2% aOR, [95% CI] 1.23 [1.02, 1.49]) and neurologic neonatal morbidity (0.8% vs 0.3% 2.53 [1.08, 5.91]). Among the components of the composite outcomes, neonates of obese women were more likely to have hypothermia treatment, suspected sepsis, and hypoxic ischemic encephalopathy. Obesity is an independent risk factor for significant neonatal morbidity. Even in the absence of HTN or DM, neonates of obese patients are at increased risk for hypoxic ischemic encephalopathy, sepsis, and needing hypothermia treatment.