Cesarean Delivery In Obese Women Research Articles

1054 Predictors of surgical-site infection after cesarean delivery in obese women receiving evidence-based preventive measures

Obesity increases the risk of both cesarean delivery and surgical site infections. Our objective was to estimate patient and operative predictors of surgical-site infection after cesarean in a contemporary cohort of obese women who received evidence-based preventive measures. Secondary analysis of data from a multicenter randomized trial in which obese women (pre-pregnancy BMI > 30kg/m2) undergoing planned or unplanned cesarean delivery were randomized to either prophylactic negative pressure wound therapy (n=806) or standard wound dressing (n=802). Participants received standard evidence-based infection prevention measures. The primary outcome was superficial, deep or organ-space surgical-site infection according to the Centers for Disease Control and Prevention definitions. Univariable and multivariable analysis were used to estimate independent patient and surgical predictors of surgical site infection. Of the 1608 participants, 60 (3.7%) were diagnosed with surgical site infection. There was no significant difference in surgical-site infection by randomization group, and the two groups were combined for this analysis. Several patient and surgical characteristics were associated with a higher risk of surgical site infection. In multivariable analysis, tobacco use, chorioamnionitis and depth of subcutaneous tissue were associated with an increased risk of surgical site infection. Use of cefazolin prophylaxis, compared with non-cefazolin antibiotics, was associated with lower risk (Table). The multivariable model based on these variables was moderately predictive (area under the curve: 0.70, Figure). The risk of surgical-site infection in obese women after cesarean is relatively low when evidence-based preventive measures are used. Smoking cessation, closure of the subcutaneous layer and cefazolin prophylaxis may be modifiable factors to further minimize infection risk in this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Influence of weight gain on risk for cesarean delivery in obese pregnant women by class of obesity: pregnancy risk assessment monitoring system (PRAMS)

Background Currently, all obese women in the United States (US) are recommend to gain the same amount of weight during pregnancy, regardless of class of obesity. Limited literature has looked at the risk of cesarean, and possible mitigation of this risk, by specific class of obesity. Objective To determine the influence of weight gain on the odds of cesarean delivery for obese women (as determined by pre-pregnancy body mass index [BMI]), by class of obesity. Study design Retrospective cohort, from the Pregnancy Risk Assessment Monitoring System (PRAMS) in the US. Specifically, the unadjusted odds of cesarean delivery were determined for each class of BMI (underweight, normal weight, overweight, class I obesity, class II obesity, and class III obesity). These odds were then adjusted by demographic and prenatal care factors influencing either weight gain during pregnancy or risk of cesarean delivery. Finally, the association of weight gain (insufficient <11 lbs, adequate 11–20 lbs, and excessive >20 lbs) on the odds of cesarean delivery in obese women was noted via multivariate logistic regression analysis. Results 60,431 women (including 21,208 with a cesarean delivery) were included in this study, with an adjusted odds ratios (OR) of cesarean delivery by BMI: underweight 0.92 (95% CI 0.83, 1.01), normal weight (referent group), overweight 1.38 (95% CI 1.32, 1.45), class I obesity 1.77 (95% CI 1.68, 1.88), class II obesity 2.17 (95% CI 2.02, 2.34), and class III obesity 3.07 (95% CI 2.82, 3.34). Class I and II obese women are more likely to have a cesarean with excessive weight gain, with class I OR 1.20 (95% CI 1.06, 1.36) and class II OR 1.24 (1.04, 1.48) when compared to women in their same class of obesity with adequate weight gain. There was no difference in risk for cesarean for class III obese women by weight gain. Conclusion Although obesity is a known risk factor for cesarean delivery, this risk is thought to be mitigatable by appropriate weight gain during the pregnancy. Weight gain of 11–20 pounds was associated with the least risk of cesarean delivery among obese (specifically class I and II) individuals.

The association of skin incision placement during cesarean delivery with wound complications in obese women: a systematic review and meta-analysis

Objective To determine the risk of wound complications by skin incision type in obese women undergoing cesarean delivery. Data sources: Electronic databases (MEDLINE, Scopus, and Ovid) were searched from their inception through August 2018. Methods of study selection: We included all randomized controlled trials and cohort studies reporting the placement of skin incision during cesarean section in obese women, defined as those with BMI ≥30 kg/m2. Studies were included if they compared one placement of skin incision with a different one as comparison group. The primary outcome was incidence of wound complications, while secondary outcomes included wound infection, hematoma, seroma, postpartum hemorrhage, and endometritis. Demographics and outcomes for each individual study identified were reported as part of the review. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of mean difference (MD) or relative risk (RR) with 95% confidence interval (CI). Sub-group analyses (vertical versus Pfannenstiel) were also reported. Tabulation, integration and results: Seventeen studies (including 3 RCTs; 8960 participants among the 15 non-overlapping studies) were included in the systematic review. Vertical incisions were associated with a relative risk of 2.07 (95% CI1.61–2.67) for wound complications compared to transverse incisions, however significant possible confounders were present. Studies were mildly-moderately heterogeneous (I 2 44.81%, 95% CI 0.00–71.85%) with varying definitions of obesity and wound complications. High transverse incisions (3 studies, 218 participants) trend toward a lower risk of wound complications compared to low transverse incisions (RR 0.338, 95% CI 0.114–1.004). Conclusions Vertical incisions may be associated with an increased risk for wound complications compared to transverse incisions for cesarean delivery in obese women. Randomized controlled trials are needed to evaluate optimal cesarean skin incisions for these women.

Induction of Labor Compared With Expectant Management and Risk of Cesarean Delivery in Obese Women [7F

INTRODUCTION: Obesity is a known independent risk factor for stillbirth. The obesity related stillbirth risk increases with advancing gestational age. There is no clear consensus regarding antepartum surveillance to reduce the risk of stillbirth. Therefore, the timing of delivery is a concern for the obstetric provider. The purpose of this study is to determine if obesity increases cesarean delivery rates in elective inductions at term when compared to expectant management. Antepartum, intrapartum, and neonatal complications were also compared between the groups. METHODS: This is a retrospective chart review of women delivered after 37 weeks gestation and with a BMI greater than 30 kg/m2 between 2015-2016 at our institution. Women admitted for elective induction of labor (N=104) were compared to those admitted in spontaneous labor (N=144). Medical indications for inductions of labor, malpresentation, fetal anomalies, and multiple gestations were excluded. Institutional Review Board approval was obtained. RESULTS: Maternal characteristics were similar between the two groups (p&gt;0.05). There were no significant differences in antepartum, intrapartum and neonatal complications between the groups (p&gt;0.05). There are no stillbirths in either group. The rate of cesarean delivery is significantly higher (p=0.029) for patients admitted for elective induction (43.3%) compared to those admitted in spontaneous labor (27.8%). CONCLUSION: Expectant management in obese women is associated with decreased rates of cesarean delivery without increased incidence of adverse outcomes compared to elective induction of labor.

972: Negative pressure wound therapy does not prevent wound complications after cesarean delivery in obese women

Obese women undergoing cesarean delivery are at increased risk for wound complications. Negative pressure wound therapy (NWPT) has been proposed as treatment modality to reduce these complications. The results of randomized and cohort studies have been contradictory as have been those of meta-analyses. We conducted a comprehensive systematic review with meta-analysis to assess the effect of NWPT on wound complications after cesarean delivery in obese women. We searched electronic databases to identify randomized controlled trials (RCTs) and cohort studies that compared the efficacy of NPWT with standard dressing in preventing wound complications after cesarean delivery in obese women. Our primary and secondary outcomes were a composite of wound complications and surgical-site infections respectively. Odds ratios with their 95% confidence intervals were calculated using a random-effects model. RCTs and cohort studies were analyzed separately and combined results were also obtained. We performed sensitivity analysis by investigating the influence of each individual study on the overall summary estimate. Published and unpublished studies were included without language restrictions. Fourteen trials consisting of 4,055 participants (1,599 from RCTs and 2,456 from cohort studies) were included for analysis. We found a non-significant decrease in risk for wound complications when RCTs and cohort studies were analyzed separately (OR 0.76; 95% CI 0.58, 1.01) and (OR 0.90; 95% CI 0.64, 1.26) respectively. Similar results were found when both types of studies were combined (OR 0.82; 95% CI 0.66, 1.02). We also found no difference in risk of surgical-site infections when pooling RCTs and cohort studies separately (OR 0.76; 95% CI 0.44, 1.30) and (OR 0.63; 95% CI 0.27, 1.47) or combining them (OR 0.71; 95% CI 0.46, 1.10). Stepwise sequential omission of each individual study did not impact the overall pooled results. In obese women undergoing cesarean delivery, negative-pressure wound therapy does not reduce risk of wound complications or surgical-site infections.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A Randomized Trial of Phenylephrine Infusion Versus Bolus Dosing for Nausea and Vomiting During Cesarean Delivery in Obese Women

(Can J Anesth. 2018;65(3):254–262) Hypotension is a common complication of cesarean delivery with spinal anesthesia and can cause intraoperative nausea and/or vomiting (IONV). Bolus dosing of phenylephrine has been shown to be an effective treatment for hypotension, but it does not treat or prevent IONV. Prophylactic phenylephrine infusion, however, has been shown to reduce the incidence of hypotension as well as maternal nausea and vomiting. However, previous studies excluded obese women. This multicenter, randomized, double-blinded study compared phenylephrine infusion to phenylephrine boluses, hypothesizing that IONV incidence would be lower with prophylactic phenylephrine infusion.

Postoperative Antimicrobial Prophylaxis Following Cesarean Delivery in Obese Women: An Exception to the Rule?

(JAMA 2017;318(11):1012–1013) Cesarean delivery represents approximately a third of all US births and is the most important risk factor for postpartum infection. Obesity is one of the most common risk factors for postcesarean surgical site infection (SSI).

Impact of excessive pre-pregnancy body mass index and abnormal gestational weight gain on pregnancy outcomes in women with chronic hypertension.

To investigate the effects of excessive pre-pregnancy body mass index (BMI) and abnormal gestational weight gain on adverse outcomes in women with chronic hypertension (CH). A retrospective cohort study of CH women with singleton pregnancy delivered at our Institution in 2002-2013. Women were categorized as normal, overweight, and obese, according to their pre-pregnancy BMI. Further stratification was based on gestational weight gain (insufficient, adequate, and excessive) as defined by 2009 IOM guidelines. Gestational diabetes, hypothyroidism, superimposed preeclampsia, preterm birth <37 weeks, cesarean section, and delivery of a small or large for gestational age neonate. 309 women met inclusion criteria. Obese women had increased odds of gestational diabetes (aOR, 3.18; 95% CI, 1.46-6.90), hypothyroidism (aOR, 2.41; 95% CI, 1.15-5.54), and superimposed preeclampsia (aOR, 2.36; 95% CI, 1.20-4.65), compared to normal BMI. Overweight women also displayed higher risk of diabetes (aOR 2.19; 95% CI, 1.05-5.03). Insufficient weight gain increased odds of small for gestational age neonate in normal BMI women (aOR, 1.82; 95% CI 1.31-2.07), whereas excessive gain was associated with superimposed preeclampsia in normal BMI patients (aOR, 3.51; 95% CI, 1.16-7.89) and with cesarean delivery in obese women (aOR, 2.96; 95% CI, 1.09-5.81). Excessive pre-conception BMI and abnormal gestational weight gain increase odds of pregnancy complications in CH women. Our results stress the importance of pre-conception counseling for weight normalization in CH women, and support IOM recommendations for adequate weight gain during CH pregnancies.

812: Weight gain in obese pregnant women and risk for cesarean delivery by class of obesity: pregnancy risk assessment monitoring system (PRAMS)

To determine the influence of weight gain on the odds of cesarean delivery for obese women (as determined by pre-pregnancy body mass index [BMI]), specifically by class of obesity. This is a secondary data analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS) in the United States (Centers for Disease Control and Prevention). The unadjusted odds ratios for cesarean delivery were determined for each class of BMI (underweight, normal weight, overweight, class I obesity, class II obesity, and class III obesity). These odds were then adjusted by demographic and prenatal care factors (maternal age, marital status, race, ethnicity, education) influencing either weight gain during pregnancy or risk of cesarean delivery on univariate analysis. The association of weight gain (insufficient <11 lbs, appropriate 11-20 lbs, and excessive >20 lbs) on the odds ratios of cesarean delivery in obese women was evaluated via multivariate logistic regression analysis. Thirty-two states contributed to the dataset (n=57,866 women), (Figure 1). The adjusted odds ratios (aOR) of cesarean delivery by BMI were: underweight 0.92 (95% CI 0.83, 1.01), normal weight (referent group), overweight 1.38 (95% CI 1.32, 1.45), class I obesity 1.77 (95% CI 1.68, 1.88), class II obesity 2.17 (95% CI 2.02, 2.34), and class III obesity 3.07 (95% CI 2.82, 3.34). Class I and II obese women were more likely to have a cesarean with excessive weight gain, with class I OR 1.20 (95% CI 1.06, 1.36) and class II OR 1.24 (1.04,1.48) when compared to women in their same class of obesity with appropriate weight gain (Figure 2). Although obesity is a known risk factor for cesarean delivery, this risk is thought to be mitigatable by appropriate weight gain during the pregnancy. Weight gain of <20 pounds was associated with the least risk of cesarean delivery among obese (specifically Class I and II) individuals.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

811: Incision location during cesarean delivery in obese women and post-operative wound complications: a systematic review and meta-analysis

811: Incision location during cesarean delivery in obese women and post-operative wound complications: a systematic review and meta-analysis

Prophylactic Negative Pressure Wound Therapy in Obese Patients Following Cesarean Delivery.

Negative pressure therapy (NPT) offers the potential to reduce infection in obese patients. The goal of this study was to explore the association between NPT use and infection after cesarean delivery among obese women. We initiated a hospital protocol wherein women with a body mass index (BMI) of 40 kg/m2 or greater who delivered after January 1, 2011 were to receive NPT following cesarean section. A retrospective comparison of surgical site infection (SSI) in women receiving the intervention to a similar group with a BMI of 40 kg/m2 or greater, a historical control group of women who delivered before January 1, 2011. Incidence of SSI was compared between time periods using logistic regression models. A total of 233 patients in the preintervention (control) group and 234 patients in the intervention group were included in the analysis. In the control group, 23 (9.9%) developed SSI, compared with 13 (5.6%) in the intervention group. After adjustment for potential confounding factors, women in the postintervention period experienced a statistically significant reduction in SSI rates (adjusted odds ratio =0.45, 95% CI = 0.22-0.95); P = .04). Implementation of a hospital protocol of NPT following cesarean delivery in obese women resulted in reduced incidence of postoperative SSI. This study suggests that using NPT after cesarean delivery in women with a BMI ≥40 kg/m2 is an efficacious method to reduce incidence of postoperative wound infections.

Attempted and Successful Vacuum-Assisted Vaginal Delivery by Prepregnancy Body Mass Index.

To examine rates of attempted and successful vacuum-assisted vaginal delivery by prepregnancy body mass index (BMI). We conducted a retrospective cohort study of 2,084 women with singleton gestations needing operative delivery assistance and vacuum-eligible (fully dilated, +2 station or greater, 34 weeks of gestation or greater) using 2006-2014 inpatient records. Prepregnancy BMI was categorized as underweight (less than 18.5), normal weight (18.5 to less than 25), overweight (25 to less than 30), or obese (30 or greater). Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) of attempted and successful vacuum-assisted vaginal delivery by prepregnancy BMI adjusted for age, race, marital status, parity, diabetes, labor induction-augmentation, episiotomy, gestational age, and neonatal birth weight. Thirty-nine percent of women requiring delivery assistance and eligible for a vacuum were overweight or obese, 79% had vacuum attempts, and 95.3% of attempted vacuum-assisted vaginal deliveries were successful. Compared with women who were normal weight prepregnancy (82.8%), women who were overweight or obese were less likely to have vacuum attempted (75.8%, OR 0.71, 95% CI 0.53-0.96 and 71.2%, OR 0.53, 95% CI 0.39-0.74, respectively). Among women with attempted vacuum-assisted vaginal delivery, successful delivery did not differ by prepregnancy BMI (92.6%, OR 0.54, 95% CI 0.21-1.37 for underweight; 94.5%, OR 1.07, 95% CI 0.57-2.00 for overweight; 96.3%, OR 1.09, 95% CI 0.51-2.33 for obese compared with 95.6% among normal-weight women). Among women in need of operative delivery assistance, prepregnancy obesity was associated with lower likelihood of attempted vacuum-assisted vaginal delivery but, if attempted, success rates were similar to rates among normal-weight women. With significant morbidity of second-stage cesarean delivery in obese women, research should examine whether vacuum-assisted vaginal delivery may be appropriate for additional obese patients.

910: Maternal and surgical factors associated with surgical site infections after cesarean delivery in obese women with intact membranes

910: Maternal and surgical factors associated with surgical site infections after cesarean delivery in obese women with intact membranes

220: Primary Cesarean Delivery in Obese Women

220: Primary Cesarean Delivery in Obese Women

Increased 3-gram cefazolin dosing for cesarean delivery prophylaxis in obese women

The purpose of this study was to determine tissue concentrations of cefazolin after the administration of a 3-g prophylactic dose for cesarean delivery in obese women (body mass index [BMI] >30 kg/m(2)) and to compare these data with data for historic control subjects who received 2-g doses. Acceptable coverage was defined as the ability to reach the minimal inhibitory concentration (MIC) of 8 μg/mL for cefazolin. We conducted a 2-phase investigation. The current phase is a prospective cohort study of the effects of obesity on tissue concentrations after prophylactic 3-g cefazolin doses at the time of cesarean delivery. Concentration data after 3-g were compared with data for historic control subjects who had received 2-g. Three grams of parenteral cefazolin was given 30-60 minutes before skin incision. Adipose samples were collected at both skin incision and closure. Cefazolin concentrations were determined with the use of a validated high-performance liquid chromatography assay. Twenty-eight obese women were enrolled in the current study; 29 women were enrolled in the historic cohort. BMI had a proportionally inverse relationship on antibiotic concentrations. An increase of the cefazolin dose dampened this effect and improved the probability of reaching the recommended MIC of ≥8 μg/mL. Subjects with a BMI of 30-40 kg/m(2) had a median concentration of 6.5 μg/g (interquartile range [IQR], 4.18-7.18) after receiving 2-g vs 22.4 μg/g (IQR, 20.29-34.36) after receiving 3-g. Women with a BMI of >40 kg/m(2) had a median concentration of 4.7 μg/g (IQR, 3.11-4.97) and 9.6 μg/g (IQR, 7.62-15.82) after receiving 2- and 3-g, respectively. With 2 g of cefazolin, only 20% of the cohort with a BMI of 30-40 kg/m(2) and none of the cohort with a BMI of >40 kg/m(2) reached an MIC of ≥8 μg/mL. With 3-g, all women with a BMI of 30-40 kg/m(2) reached target MIC values; 71% of the women with a BMI of >40 kg/m(2) attained this cutoff. Higher adipose concentrations of cefazolin were observed after the administration of an increased prophylactic dose. This concentration-based pharmacology study supports the use of 3 g of cefazolin at the time of cesarean delivery in obese women. Normal and overweight women (BMI <30 kg/m(2)) reach adequate cefazolin concentrations with the standard 2-g dosing.

Attempted and Successful Vacuum-Assisted Vaginal Delivery in Relation to Prepregnancy Body Mass Index [138

INTRODUCTION: Obese women have longer active phase of stage I labor, altered uterine contractility, and higher risk of emergent cesarean delivery. With cesarean delivery posing increased morbidity, motivation is high for women to deliver vaginally. However, large-for-gestational-age neonates, which are more prevalent among obese women, are associated with operative vaginal delivery failure. We examined rates of attempted and successful vacuum-assisted vaginal deliveries among laboring women in relation to prepregnancy body mass index (BMI, calculated as weight (kg)/[height (m)]2). METHODS: We conducted a retrospective cohort study (2006–2014) of laboring women with singleton gestations greater than 34 weeks of gestation (N=14,673). A clinical database derived from obstetric records provided data. Vacuum-assisted vaginal deliveries were confirmed by chart audit. Prepregnancy BMI was categorized as normal weight (18.5–24.9), overweight (25–29.9), obese class I (30–34.9), obese class II (35–39.9), or obese class III (40 or higher). RESULTS: Nearly half (44%) were overweight or obese and 10.7% had vacuum-assisted vaginal delivery. Compared with women with normal BMIs, those who were overweight, obese class I, class II, and class III were less likely to have vacuum attempted (adjusted odds ratio [OR] 0.80, 0.85, 0.65, and 0.59, respectively). However, among those with attempted vacuum, successful vacuum-assisted vaginal delivery did not differ by prepregnancy BMI (adjusted OR 0.40, 95% confidence interval 0.16–1.04; OR 1.17, 95% CI 0.62–2.21; OR 1.37, 95% CI 0.62–3.01, for underweight, overweight, and obese women, respectively) compared with normal weight. CONCLUSION AND IMPLICATION: Higher prepregnancy BMI is associated with lower likelihood of vacuum-assisted vaginal delivery attempt but not vacuum-assisted vaginal delivery success. With increased morbidity of second stage cesarean delivery in obese women compared to vacuum-assisted vaginal delivery, clinicians should consider attempting vacuum extraction in appropriate obese patients.

Term Elective Induction of Labor and Risk of Cesarean Delivery in Obese Women [326

Term Elective Induction of Labor and Risk of Cesarean Delivery in Obese Women [326

810: Emergency cesarean delivery in obese women: delivery and neonatal outcomes

women: delivery and neonatal outcomes Robert Ehsanipoor, Mathew Goldshore, Haitham Baghlaf, Janice Henderson, Irina Burd, Erika Werner The Johns Hopkins University, Gynecology and Obstetrics, The Johns Hopkins University, Bloomberg School of Public Health OBJECTIVE: To compare delivery and neonatal outcomes of morbidly obese women (BMI or 40 kg/m2) to those with a BMI of less than 40 kg/m2 undergoing emergency cesarean delivery. STUDY DESIGN: A retrospective cohort study of all singleton pregnancies undergoing emergent Cesarean delivery at an academic institution from 2004 2011. Body mass index was calculated based on the weight at delivery. Outcomes for women with a BMI of or 40 kg/m2 were compared to those with a BMI of 40 kg/m2. Women undergoing an unscheduled Cesarean delivery with an indication of non-reassuring fetal heart rate tracing, vaginal bleeding, suspected uterine rupture, or cord prolapsed were included. Women with abnormal labor progression, malpresentation, or that presented in labor prior to a scheduled Cesarean were not included unless they also had one of the above mentioned indications. The primary outcome was the time from decision to perform a Cesarean to incision. Wilcoxan rank sum test was used to evaluate continuous variables. Chi squared and logistic regression tests were used to evaluate dichotomous outcomes. RESULTS: A total 102/456 (22.4%) women had a BMI of or 40 kg/m. There were no significant differences between the groups in regard to age, parity, previous Cesarean delivery, or epidural use during labor. Morbid obesity was associated with a significantly greater median decision to incision time (41 vs 30.5 mins; p 0.04), length of surgery (71 vs 58.5 mins; 0.01), and estimated blood loss (900 vs 800 ml; p 0.01). There was not a significant difference in the need for general anesthesia (OR 1.7; 95% CI 0.9-3.3), or NICU admission (OR 1.3; 95% CI 0.8-2.1). CONCLUSION: Emergency Cesarean delivery in morbidly obese women is associated with longer decision to incision intervals, length of surgery, and a greater blood loss. These factors need to be considered when counseling and managing morbidly obese women.

Obesity and gestational weight gain: cesarean delivery and labor complications

To assess the association between pre-gestational obesity and weight gain with cesarean delivery and labor complications. A total of 4,486 women 20-28 weeks pregnant attending general prenatal care clinics of the national health system in Brazil from 1991 to 1995 were enrolled and followed up through birth. Body mass index categories based on prepregnancy weight and total weight gain were calculated. Associations between body mass index categories and labor complications were adjusted through logistic regression analysis. Obesity was present in 308 (6.9%) patients. Cesarean delivery was performed in 164 (53.2%) obese, 407 (43.1%) pre-obese, 1,045 (35.1%) normal weight and 64 (24.5%) underweight women. The relative risk for cesarean delivery in obese women was 1.8 (95% CI: 1.5-2.0) compared to normal weight women. Greater weight gain was particularly associated with cesarean among the obese (RR 4th vs 2nd weight gain quartile 2.2; 95% CI: 1.4-3.2). Increased weight at the beginning of pregnancy was associated with a significantly higher adjusted risk of meconium with vaginal delivery and perinatal death and infection in women submitted to cesarean section. Similarly, greater weight gain during pregnancy increased the risk for meconium and hemorrhage in women submitted to vaginal delivery and for prematurity with cesarean. Pre-gestational obesity and greater weight gain independently increase the risk of cesarean delivery, as well as of several adverse outcomes with vaginal delivery. These findings provide further evidence of the negative effects of prepregnancy obesity and greater gestational weight gain on pregnancy outcomes.

Association between pre-pregnancy obesity and the risk of cesarean delivery

To explore the relationship between pre-pregnancy obesity and the risk for cesarean delivery. The population studied included 20,130 women with live births after 20 weeks' gestation in central New York state between June 1, 1994, and May 31, 1995. Women who were obese before pregnancy were compared with nonobese women with regard to mode of delivery. Obesity was defined as body mass index (BMI) greater than 29. Separate analyses were conducted on the entire sample and on a subset of women with singleton pregnancies and no prior cesarean deliveries, as an estimate of the risk of primary cesarean delivery in obese women. Statistical analyses included chi 2 test, crude odds ratio (OR) with 95% confidence interval (CI), and adjusted OR with 95% CI, using logistic regression to control for confounding variables. The adjusted OR was 1.64 (95% CI 1.46, 1.83) for obese women with singleton pregnancies and no prior cesarean deliveries to undergo cesarean delivery. The adjusted OR was 1.66 (95% CI 1.51, 1.82) for obese women in the entire sample to undergo cesarean delivery. In addition, increasing BMI was associated with increased risk for cesarean delivery. Compared with nonobese women, women who are obese before pregnancy are at increased risk for cesarean delivery. Preconceptional counseling regarding dietary and life-style modifications may alter this pattern.