833: Should gestational weight loss be encouraged for obese women?

Abstract

be encouraged for obese women? Saju Joy, Niki Istwan, Debbie Rhea, Cheryl Desch, Gary Stanziano Carolinas Medical Center, Maternal-Fetal Medicine, Charlotte, NC, Alere Health, Department of Clinical Research, Atlanta, GA OBJECTIVE: The current pregnancy weight gain recommendation of 11-20lbs for obese women, regardless of obesity class, continues to be debated. We sought to examine pregnancy outcomes in obese women according to gestational weight gain and level of obesity. STUDY DESIGN: Women with an obese pre-pregnancy body-mass index (BMI) and current singleton pregnancy enrolled in a maternity risk screening and education program at 20w were identified. Women with a pre-pregnancy diagnosis of diabetes were excluded. Data were classified according to reported pregnancy weight gain (losing weight, under-gaining, within target, and over-gaining) and by obesity class (Class 1 BMI 30-34.9, Class 2 35-39.9, Class 3 40-49.9, Class 4 50). The recommended range of 11-20lbs for pregnancies with gestational age at delivery (GAD) 37w was used to determine weight gain group. To control for GAD 0.51/w over-gaining. Pregnancy outcomes were compared by weight gain group overall and within obesity class using Pearson’s chi-square test statistics. RESULTS: Of the 27,898 women studied, 4.4% were losing weight (mean weight change: 13.1 / 12.5lbs), 10.0% were under-gaining (mean change: 5.8 / 3.4lbs), 20.4% were gaining within target (mean change: 16.2 / 3.0lbs) and 65.2% were over-gaining (mean change: 36.8 / 12.8lbs). Pregnancy outcomes (see Table) were similar for the weight loss and under-gaining groups. Excessive weight gain was associated with adverse outcomes. These results were also observed within obesity classes 1, 2, and 3. However, for women in obesity class 4 no differences were observed between weight gain groups. CONCLUSION: Compared to women gaining weight within established guidelines, weight loss during pregnancy was associated with lower rates of macrosomic and LGA infants, but higher rates of preterm delivery and SGA infants. A reduction in cesarean delivery or gestational HTN/preeclampsia was not observed for women under-gaining or with weight loss. These data do not support recommending weight gain below current guidelines, although excessive weight gain should be discouraged for obese gravidas. 834 “Isolated” obesity: still an independent risk factor for cesarean delivery Shimrit Yaniv Salem, Ruslan Sergienko, Gershon Holcberg, Eyal Sheiner Soroka University Medical Center, Ben-Gurion University of the Negev, Department of Obstetrics and Gynecology, Faculty of Health Sciences, Beer-Sheva, Israel, Ben Gurion University of the Negev, Faculty of Health Sciences, Ben-Gurion University of the Negev Epidemiology and Health Services Evaluation Department, Beer Sheva, Israel, Soroka University Medical Center, Ben-Gurion University of the Negev, Department of Obstetrics and Gynecology, Beer-Sheva, IL, Israel, Soroka University Medical Center, Ben-Gurion University of the Negev, Department of Obstetrics and Gynecology, Beer-Sheva, Israel OBJECTIVE: To investigate pregnancy outcome among women with “isolated” obesity (i.e. without additional co-morbidities) and specifically the correlation between “isolated” obesity and cesarean delivery (CD). STUDY DESIGN: A population-based study was performed comparing all pregnancies of obese (maternal pre-pregnancy body mass index [BMI] of 30 kg/m2 or more) and non-obese patients, between the years 1988 and 2010. Patients with chronic hypertension, pre-gestational diabetes mellitus, other preexisting chronic morbidities, multiple gestations, patients older than 40 years old, grand-multiparity (above 5 deliveries), patients lacking prenatal care, and patients following fertility treatments were excluded from the analysis. Stratified analyses, using multiple logistic regression models were performed to control for confounders RESULTS: During the study period there were 173,628 deliveries meeting the inclusion criteria, of which 1605 (0.9%) occurred in patients with “isolated” obesity. Conditions significantly associated with maternal “isolated” obesity, using a multivariable model are presented in the table. Higher rates of CD were found among patients with “isolated” obesity (30.7% vs. 12.3%; OR 3.2; 95% CI 2.8, 3.5; P 0.001). When controlling for possible confounders, using another multivariable model with CD as the outcome variable, the association between “isolated” obesity and CD remained significant (adjusted OR 2.6; 95% CI 2.3-3.0, P 0.001). No significant differences were noted between the groups regarding perinatal complications such as perinatal mortality, congenital malformations, shoulder dystocia and low Apgar scores at 5 minutes. CONCLUSION: “Isolated” obesity, although not a risk factor for adverse perinatal outcomes is an independent risk factor for CD www.AJOG.org Academic Issues, Antepartum Fetal Assessment, Genetics, Hypertension, Medical-Surgical-Disease Poster Session V