Maternal Weight Gain and Neonatal Outcomes in Women With Class III Obesity [29C

Abstract

INTRODUCTION: Class III obesity is an independent risk factor for neonatal morbidity. Institute of Medicine (IOM) guidelines recommend 11-20 lbs of gestational weight gain (GWG) in women with obesity. We evaluated the association between GWG and neonatal outcomes in women with Class III obesity. METHODS: Retrospective cohort of women delivering a liveborn neonate at term at a single institution between 7/2013-12/2017 with a baseline BMI ≥40 in the first trimester. Pregnancies complicated by multiple gestation or fetal anomalies were excluded. Primary outcome was a neonatal composite including 5 m apgar <7, intubation, grade 3/4 IVH, sepsis or intensive care unit (NICU) admission. Secondary outcomes included NICU admission >7 days. Demographic, pregnancy & delivery characteristics of women who gained >20 lbs (mIOM) were compared to those that gained <20 lbs (lIOM) using bivariate statistics. Stepwise backward regression was used to estimate odds ratios. RESULTS: Of 374 women, 144 (38.5%) gained mIOM, who were less likely to be multiparous, use tobacco or have a lower BMI at delivery. The neonatal composite occurred in 30 (8.0%) neonates, 16 (11.1%) in mIOM versus 14 (6.1%) in the lIOM group (p=0.12, OR=1.93, 95% CI 0.91,4.08). When adjusted for multiparity and BMI at delivery, the aOR was 1.55 (95% CI 0.85-2.82). Neonates in the mIOM group were more likely to be admitted to the NICU (10.4% v 4.4%, p=0.03, OR=2.56, 95% CI 1.12-5.86) and have an admission >7days (6.9% v 2.2%, p=0.03, OR=3.36, 95% CI 1.12-10.03). CONCLUSION: In women with class III obesity, excess GWG was associated with increased odds of NICU admission and admission >7 days.