Gestational Weight Gain Is Not Associated With Risk of Fetal Acidosis in Scheduled Cesarean Deliveries [ID 2683603

Abstract

INTRODUCTION: Obesity is associated with fetal acidosis at time of scheduled cesarean delivery (CD). Although excessive gestational weight gain (GWG) is associated with adverse pregnancy outcomes, it is not known whether GWG is associated with fetal acidosis at time of scheduled CD. METHODS: This was an IRB-approved retrospective cohort study of term, singleton, non-anomalous deliveries by scheduled cesarean under neuraxial anesthesia at Mount Sinai Hospital from 2013 to 2019. Gestational weight gain was the difference between pre-pregnancy or first-trimester weight and delivery weight. Gestational weight gain appropriateness was defined by Institute of Medicine recommendations: insufficient, appropriate, excessive. Primary outcome was fetal acidosis defined as umbilical arterial pH less than 7.1. Demographics were compared using chi-squared analysis and the association between GWG and fetal acidosis was evaluated with multivariable logistic regression. RESULTS: Of 2,435 individuals included, 1,046 (43%) had excessive, 749 (31%) had appropriate, and 640 (26%) had insufficient GWG. Incidence of fetal acidosis was 0.8%, 1.7%, and 1.9% among populations with insufficient, appropriate, and excessive GWG, respectively (P=.2). Across groups, rates of insurance status, history of cesarean delivery, and anesthesia type were similar. Compared to appropriate GWG, the excessive GWG group had higher rates of early pregnancy obesity (P=.001). After adjusting for early pregnancy weight, age, cesarean history, insurance type, and anesthesia type, excessive GWG was not associated with increased odds of fetal acidosis (adjusted odds ratio [aOR] 1.01 [0.49, 2.14]). CONCLUSION: Neither excessive nor insufficient GWG are associated with increased risk for fetal acidosis in term, scheduled CD. Association between obesity and fetal acidosis are likely unrelated to GWG.