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Abstract
BackgroundWorldwide there has been a dramatic increase in the prevalence of overweight and obesity in women of childbearing age. Growing evidence suggests that maternal overweight and obesity is associated with poor maternal and perinatal outcomes. This study evaluated the impact of maternal pre-pregnancy overweight and obesity on pregnancy, labour and delivery outcomes in a cohort of women with term, singleton pregnancies cared for by family physicians in community based practices.MethodsThis study is a secondary analysis of the All Our Babies Cohort, a prospective, community-based pregnancy cohort in Calgary, Alberta. Maternal self-reported data on height and pre-pregnancy weight from term, singleton, cephalic pregnancies (n = 1996) were linked to clinical data on pregnancy and birth events retrieved from electronic health records. Descriptive and bivariate regression analysis were used to compare pregnancy and birth outcomes between women categorized as normal weight, overweight and obese based on the pre-pregnancy BMI. Multinomial regression analysis stratified by type of labour onset examined the association between pre-pregnancy BMI and mode of delivery controlling for maternal age, pre-existent health conditions, parity, fertility treatments, history of C-section and pregnancy complications.ResultsThe cohort consisted of 65.8% normal weight, 23.6% overweight and 10.6% obese women. Women with increased pre-pregnancy BMI were more likely to develop pregnancy complications such as preeclampsia (OR 3.5, CI 2.0-4.6 for overweight; OR 5.3, CI 3.3-8.5 for obese) and gestational diabetes (OR 3.0, CI 1.8-5.0 for overweight; OR 6.5, CI 3.7-11.2 for obese) than normal weight women. Spontaneous onset of labour was recorded in 71.2% of women with normal pre-pregnancy BMI, whereas 39.3% of overweight and 49% of obese women had their labour induced. For women with spontaneous labour, pre-pregnancy BMI was not a significant risk factor for mode of delivery, controlling for covariates. Among women with induced labor, obesity was a significant risk factor for delivery by C-section (adjusted OR 2.2; CI 1.2-4.1).ConclusionsEven among women with term, singleton pregnancies obtaining prenatal care in community-based settings, obese women who undergo labour induction are at increased risk of obstetrical interventions at delivery. These findings highlight the importance of tailored maternal care in pregnancy and at delivery of pregnant women with increased BMI in order to improve the outcomes and wellbeing of these women and their children.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-014-0422-y) contains supplementary material, which is available to authorized users.
Highlights
Worldwide there has been a dramatic increase in the prevalence of overweight and obesity in women of childbearing age
Spontaneous onset of labour was recorded in 71.2% of women with normal pre-pregnancy body mass index (BMI) compared to 60.7% of overweight and 51% of obese women (p < 0.001)
Because the rates of labour induction and C-section were higher in women with increased BMI, we further examined the association between the type of labour onset, induced versus spontaneous, and the rates of Csection in obese and overweight women
Summary
Worldwide there has been a dramatic increase in the prevalence of overweight and obesity in women of childbearing age. Emerging evidence suggests obesity is associated with increased complications during pregnancy, labour and delivery, and into the postpartum period, as well as adverse neonatal outcomes which include fetal growth abnormalities such as macrosomia [5,6], neural tube defects [7], and stillbirth [8,9]. These have implications for obstetrical management and maternal and neonatal care [10,11,12]. Labour progression is significantly slower in obese women [18,19] whereas duration of labour, oxytocin requirements and caesarean delivery rates increase with increasing maternal body mass index (BMI) [19]
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