689: Pregnancy outcomes in the setting of super obesity and super-super obesity

Abstract

We sought to determine differences in pregnancy outcomes associated with maternal super obesity (Body Mass Index [BMI] ≥50) and super-super obesity (BMI ≥60) when compared with maternal morbid obesity (BMI ≥40) and obesity (BMI ≥30). We conducted a retrospective cohort study of 2,333,788 women with singleton, vertex, non- anomalous gestations and BMI ≥30, then examined rates of cesarean delivery, gestational hypertension, gestational diabetes, preterm birth, macrosomia, and Apgar score. Pre-pregnancy BMI was divided into 4 sub-groups (obese, morbidly obese, super obese, and super-super obese). Multivariate regression analyses and chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance. Overall, increased BMI was associated with a statistically significant increase in all investigated outcomes. After controlling for multiple confounders, super-super obese women were found to be more likely than obese women to deliver via cesarean (odds ratio [OR], 2.60; 95% confidence interval [CI], 2.42-2.79), deliver preterm (OR, 1.18; 95%CI, 1.05-1.33), have gestational hypertension (OR, 2.0; 95%CI, 1.80-2.22), have gestational diabetes (OR, 1.15; 95%CI, 1.05-1.24), macrosomia (OR, 1.61; 95%CI, 1.37-1.88) and 5-minute Apgar below 7 (OR, 2.16; 95%CI, 1.88- 2.48). Women with BMI ≥60 are at higher risk of pregnancy complications than women with lower levels of obesity. Though baseline obesity has been a standard indicator of risk in pregnancy, this data suggests that any reduction in obesity category could have an important impact on perinatal outcomes in obese women.