Abstract
BackgroundThe increasing prevalence of obesity in young women is a major public health concern. These trends have a major impact on pregnancy outcomes in these women, which have been documented by several researchers. In a population based cohort study, using routinely collected data, this paper examines the effect of increasing Body Mass Index (BMI) on pregnancy outcomes in nulliparous women delivering singleton babies.MethodsThis was a retrospective cohort study, based on all nulliparous women delivering singleton babies in Aberdeen between 1976 and 2005. Women were categorized into five groups – underweight (BMI < 20 Kg/m2), normal (BMI 20 – 24.9 Kg/m2) overweight (BMI 25 – 29.9 Kg/m2), obese (BMI 30 – 34.9 Kg/m2) and morbidly obese (BMI > 35 Kg/m2). Obstetric and perinatal outcomes were compared by univariate and multivariate analyses.ResultsIn comparison with women of BMI 20 – 24.9, morbidly obese women faced the highest risk of pre-eclampsia {OR 7.2 (95% CI 4.7, 11.2)} and underweight women the lowest {OR 0.6 (95% CI 0.5, 0.7)}. Induced labour was highest in the morbidly obese {OR 1.8 (95% CI 1.3, 2.5)} and lowest in underweight women {OR 0.8 (95% CI 0.8, 0.9)}. Emergency Caesarean section rates were highest in the morbidly obese {OR 2.8 (95% CI 2.0, 3.9)}, and comparable in women with normal and low BMI. Obese women were more likely to have postpartum haemorrhage {OR 1.5 (95% CI 1.3, 1.7)} and preterm delivery (< 33 weeks) {OR 2.0 (95% CI 1.3, 2.9)}. Birthweights less than 2,500 g were more common in underweight women {OR 1.7 (95% OR 1.2, 2.0)}. The highest risk of birth weights > 4,000 g was in the morbidly obese {OR 2.1 (95% CI 1.3, 3.2)} and the lowest in underweight women {OR 0.5 (95% CI 0.4, 0.6)}.ConclusionIncreasing BMI is associated with increased incidence of pre-eclampsia, gestational hypertension, macrosomia, induction of labour and caesarean delivery; while underweight women had better pregnancy outcomes than women with normal BMI.
Highlights
The increasing prevalence of obesity in young women is a major public health concern
The mean ages of overweight and obese women were comparable with women with normal Body Mass Index (BMI)
As we included all women who had booked at the Antenatal Clinic up to 16 weeks of gestation, we compared the time of booking and found no differences among the different BMI categories
Summary
The increasing prevalence of obesity in young women is a major public health concern. These trends have a major impact on pregnancy outcomes in these women, which have been documented by several researchers. The rising rate of obesity is a major public health concern in the West, where 28% of pregnant women are overweight and 11% are obese [1]. The exact incidence of obesity in pregnant women in the UK is not known, the Confidential Enquiry into Maternal and Child Health 2004 [6] reported that 35% of all maternal deaths occurring in the triennium 2000–2002 were in obese women with Body Mass Index > 30 Kg/m2. Similar reports have been published from Wales [13] and Scotland [14]
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