Maternal obesity and its effect on labour duration in nulliparous women: a retrospective observational cohort study

Karen Louise Ellekjaer,Ellen Løkkegaard,Thomas Bergholt

doi:10.1186/s12884-017-1413-6

Karen Louise Ellekjaer, Ellen Løkkegaard + Show 1 more

Open Access

https://doi.org/10.1186/s12884-017-1413-6

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Abstract

BackgroundObesity is increasing among primipara women. We aimed to describe the association between body mass index (BMI) during early-pregnancy and duration of labour in nulliparous women.MethodsRetrospective observational cohort study of 1885 nulliparous women with a single cephalic presentation from 37 0/7 to 42 6/7 weeks of completed gestation and spontaneous or induced labour at Nordsjællands Hospital, University of Copenhagen, Denmark, in 2011 and 2012.Total duration of labour and the first and second stages of labour were compared between early-pregnancy normal-weight (BMI <25 kg/m2), overweight (BMI 25–29.9 kg/m2), and obese (BMI ≥30 kg/m2) women. Proportional hazards and multiple logistic regression models were applied.ResultsEarly pregnancy BMI classified 1246 (66.1%) women as normal weight, 350 (18.6%) as overweight and 203 (10.8%) as obese. No difference in the duration of total or first stage of active labour was found for overweight (adjusted HR = 1.01, 95% CI 0.88–1.16) or obese (adjusted HR = 1.07, 95% CI 0.90–1.28) compared to normal weight women. Median active labour duration was 5.83 h for normal weight, 6.08 h for overweight and 5.90 h for obese women.The risk of caesarean delivery increased significantly for overweight and obese compared to normal weight women (odds ratios (OR) 1.62; 95%CI 1.18–2.22 and 1.76; 95%CI 1.20–2.58, respectively). Caesarean deliveries were performed earlier in labour in obese than normal-weight women (HR = 1.80, 95%CI 1.28–2.54).ConclusionBMI had no significant effect on total duration of active labour. Risk of caesarean delivery increased with increasing BMI. Caesarean deliveries are undertaken earlier in obese women compared to normal weight women following the onset of active labour, shortening the total duration of active labour.

Highlights

body mass index (BMI) was distributed according to maternal age, height, or gestational age, whereas an association between BMI and hypertensive disease and gestational diabetes was found (p < 0.01) (Table 1)
The proportion of induced births increased with increasing BMI, as did the use of oxytocin for augmentation of labour, epidural analgesia, and CTG monitoring
We found significantly increased odds ratios (OR) of caesarean delivery with increasing BMI (OR = 1.62, 95%Confidence interval (CI) 1.18–2.22 among overweight women and OR = 1.76, 95%CI 1.20– 2.58 among obese women versus women of normal weight) (Table 4)

Summary

Introduction

We aimed to describe the association between body mass index (BMI) during early-pregnancy and duration of labour in nulliparous women. Average body mass index (BMI) has increased over the past 30 years and obesity has become a global health issue [1, 2]. This tendency has a wide range of implications in the field of obstetrics as women with a higher BMI are at risk of various complications during pregnancy such as gestational diabetes, preeclampsia, macrosomia, dystocia, and stillbirths [3, 4]. In order to ensure proper labour management, perceptions about labour progression in obese women should be evidence-based and not guided by assumptions

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