Does Excessive Gestational Weight Gain Increase the Risk of Cesarean Delivery? [13E

Abstract

INTRODUCTION: To determine whether excessive gestational weight gain (GWG), as defined by the Institute of Medicine (IOM) guidelines, increases the risk of cesarean delivery (CD) in term singleton gestations. METHODS: This was a retrospective cohort study of singleton gestations at term (>37 weeks gestation), admitted for intended vaginal delivery from January to December 2015. Patients with prior CD, multiple gestation, malpresentation, or missing data were excluded. Demographics, obstetrical and neonatal characteristics, first office visit weight/BMI, and admission weight/BMI were collected from prenatal and hospital records. Women were divided into 2 groups: those with excessive GWG, and those with weight gain at or below IOM guidelines. Baseline characteristics and CD rates were compared between the 2 groups using parametric and non-parametric tests as appropriate with a P<0.05 considered statistically significant and relative risks were calculated. RESULTS: A total of 743 women met inclusion criteria with an average pre-pregnancy BMI of 25.5+/-5.6 kg/m2. The CD rate for the cohort was 19.2% (n=143). After adjusting for age, pre-pregnancy BMI, parity, and race, women with excessive GWG were 50% more likely to have a CD compared to those with lower GWG [relative risk 1.51 (1.07-2.05)]. This increased risk was greatest in nulliparous women. A trend toward increased rate of labor dystocia as an indication for CD was noted in the excessive GWG group. CONCLUSION: Women who gain more than recommended weight by the IOM guidelines, particularly if nulliparous, are at increased risk of having a CD compared to those who have appropriate weight gain.