Effect of Body Mass Index on Adverse Neonatal Outcomes in Patients With Emergency Cesarean Deliveries [ID: 1381091

Abstract

INTRODUCTION: The objective of this study was to evaluate the association of body mass index (BMI) with adverse neonatal outcomes in pregnant patients with emergency cesarean delivery (CD). METHODS: This was a retrospective cohort study of singleton nonanomalous pregnancies between 23 and 42 weeks from 2007 to 2012 in California. Pregnancies resulting in an emergency CD were stratified based by ICD-9 codes for cord prolapse, or uterine rupture. Outcomes included neonatal intensive care unit (NICU) admission, Apgar scores less than 3 at 5 minutes, infant death, respiratory distress syndrome (RDS), neonatal seizures, and hypoglycemia. After stratifying by cause of emergency CD, multivariable logistic regression models were used to evaluate associations of BMI at delivery with adverse neonatal outcomes. Models were adjusted for maternal race and ethnicity, age, education level, insurance, parity, smoking status, and prenatal care. RESULTS: Of this cohort, 1,368 had an emergent CD in the setting of cord prolapse, and 992 had an emergent CD in the setting of a uterine rupture. Of individuals with cord prolapse, patients whose BMI was classified as obesity class II had decreased odds of NICU admission, and those whose BMI was classified as obesity class III had decreased odds of NICU admission and RDS. Of individuals with a uterine rupture, patients whose BMI was classified as overweight had decreased odds of all neonatal outcomes analyzed. Those with a BMI classified as obesity class I had decreased odds of all neonatal outcomes except for neonatal seizures. Those with a BMI classified as obesity class II had decreased odds of lower Apgar scores, NICU admission, infant death, and RDS. Those with a BMI greater than 50 had increased odds of RDS and hypoglycemia. CONCLUSION: Higher BMI was associated with decreased risk of many adverse neonatal outcomes in the setting of patients delivering emergently with cord prolapse or uterine rupture. These findings may be useful in appropriately managing patients presenting with emergent CD.