626 Risk of maternal peripartum complications by mode of delivery among patients with superobesity

Abstract

Superobesity (pre-pregnancy body mass index (BMI) >=50 kg/m2) is increasingly common in the United States. Little is known about the effect of superobesity on maternal peripartum complications. We sought to determine whether superobesity is a risk factor for maternal peripartum morbidity based on mode of delivery. The 2016-18 National Center for Health Statistics natality data was queried for delivery hospitalizations 20-44 weeks gestation linked to patients with superobesity. The primary outcome was a maternal peripartum morbidity composite comprised of unplanned hysterectomy, maternal intensive care unit (ICU) admission, transfusion, and eclampsia. Composite risk was analyzed using log linear regression modeling with the primary exposure of superobesity stratified by delivery mode of vaginal delivery (VD), operative vaginal delivery (OVD), and cesarean delivery (CD) and adjusting for maternal parity, race, age, payer, and medical factors (chorioamnionitis, pregestational and gestational diabetes, chronic and gestational hypertension). Of 11.2 million delivery hospitalizations, 354,350 were linked to women with superobesity. Compared to women of normal BMI, superobese women had a lower rate of VD (58.9% v. 70.4%) and OVD (2.4% v. 3.7%) and a higher rate of primary (22.1% v. 15.8%) and repeat cesarean delivery (16.7% v. 10.0%). The incidence of maternal peripartum complications was higher for superobese women and generally increased with higher BMI (Figure). In adjusted analyses, superobese women were 33% (aRR 1.33, 95% CI: 1.29, 1.39) more likely to experience maternal peripartum complications overall and at higher risk of complications for all modes of delivery compared to patients with normal weight (Table). Women with superobesity are at higher risk of peripartum maternal morbidity including unplanned hysterectomy, ICU admission, transfusion and eclampsia in all modes of delivery. These findings highlight superobesity as an independent risk factor for maternal morbidity regardless of mode of delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)