Abstract
Objective: To evaluate the relationship between weight gain and primary cesarean delivery. Methods: This was a retrospective cohort study of women 5442 who delivered a singleton from 2009-2013. Women were classified as normal weight [pre-pregnancy body mass index (BMI) 18.5 - 24.9 kg/m2], overweight (pre-pregnancy BMI 25.0 - 29.9 kg/m2), obese (pre-pregnancy BMI 30.0 - 39.9 kg/m2), and extremely obese (pre-pregnancy BMI ≥ 40.0 kg/m2). Each BMI group was subdivided by weight gain—low, recommended, or excessive, as defined by the 2009 Institute of Medicine guidelines—and rates of primary cesarean delivery were compared. Results: The overall primary cesarean delivery rate was 27.3%, but this varied based on pre-pregnancy BMI. The primary cesarean delivery rate among women of normal weight was 22.3%, overweight women 27.5%, obese women 35.3%, and extremely obese women 45.7%. Among normal-weight, obese, and extremely obese women, the risk of primary cesarean delivery increased with excessive weight gain [normal weight odds ratio (OR) 1.63, (95% confidence interval 1.32 - 2.01); obese OR 1.55 (1.12 - 2.15); extremely obese OR 2.19 (1.18 - 4.08)] compared to recommended weight gain. More than half of women (53.2%) had excessive weight gain. Conclusion: Adherence to guidelines may decrease a woman’s risk of primary cesarean delivery.
Highlights
Cesarean delivery is among the most common major surgical procedure performed worldwide, with an estimated 18.5 million performed yearly [1]
Among pre-pregnancy normal-weight, obese, and extremely obese women, the risk of primary cesarean delivery increased with excessive weight gain [normal weight odds ratio (OR) 1.63, 95% confidence interval (CI) 1.32 - 2.01, p < 0.01; obese OR 1.55, 95% CI 1.12 - 2.15, p < 0.01; extremely obese OR 2.19, 95% CI 1.18 - 4.08, p = 0.01] compared to recommended weight gain (Figure 1)
Our study showed that pregnancy weight gain above that recommended by the Institute of Medicine increases risk for primary cesarean delivery, and this was statistically significant for normal weight, obese, and extremely obese patients
Summary
Cesarean delivery is among the most common major surgical procedure performed worldwide, with an estimated 18.5 million performed yearly [1]. A. Boyle et al 526 tal cesarean delivery rate has risen dramatically over the last two decades, especially in high- and middle-income countries [2]. In 2010, 69 of 137 countries studied had a cesarean delivery rate greater than 15% [1]. The most recent cesarean delivery rate in the United States was 32.7 [3], while in England it was 26.2% [4]. Mirroring the rise in the total cesarean delivery rate, the primary cesarean delivery rate has increased. Avoiding primary cesarean deliveries could decrease total cesarean delivery rate both directly (in the index pregnancy) and indirectly (by avoiding repeat cesarean deliveries)
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