Superobese Women Research Articles

Deciphering The Transcriptional Activities of Genes Coding For Adipokines and Their Receptors in Porcine Ex Situ-Protected Mesenchymal Stem Cells Undergoing Adipogenic Differentiation

Abstract The aim of this study was to investigate the impact of the source of mesenchymal stem cells (MSCs) and their adipogenic derivatives on the relative abundances (RAs) noticed for mRNA transcripts of the selected adipokines (adiponectin and leptin) and their receptors. MSCs were isolated from bone marrow (BM) and subcutaneous adipose tissue (AT ) samples collected post mortem from a total of four gilts (each at the age of 6 months). The stemness of the MSCs was proven via recognizing their abilities to differentiate into adipocytes, osteoblasts, and chondrocytes. By using real-time PCR (RT -qPCR), the quantitative levels of transcriptional activity pinpointed for the adiponectin (ADIPOQ), adiponectin receptor 1 (ADIPOR1), adiponectin receptor 2 (ADIPOR2), leptin (LEP), and leptin receptor (LEPR) genes were comparatively analyzed between non-differentiated AT -MSCs and BM-MSCs and their cell counterparts undergoing differentiation into adipocytes. A significantly higher RA for ADIPOR1 transcripts was identified in the AT-MSCs compared to the BM-MSCs and their adipogenic derivatives (P≤0.05). Moreover, the quantitative levels of LEPR transcripts were shown to increase significantly among adipocytes originating from differentiated BM-MSCs compared to undifferentiated BM-MSCs, AT -MSCs, and AT -MSC-derived adipocytes (P≤0.05). Nonetheless, there was no significant inter-group variability in the RAs of the ADIPOQ, ADIPOR2, or LEP mRNA transcripts (P>0.05). Cumulatively, the in vitro models focused on the identification and detailed exploration of transcriptomic signatures of undifferentiated pig BM- and AT -MSCs, and the molecular mechanisms underlying the adipogenic differentiation pathways of the above-indicated two distinct sources of stem cells were developed and optimized in the current investigation for the very first time. These ex vivo porcine models might confirm the expedited functional mobilization of ex situ-protected MSCs and their enhanced capacity to be transcriptionally reprogrammed into adipocytes due to physiopathological alterations in the expression profiles of adipokines and their receptors, which are prompted and progressed in obese and superobese women patients at the peri-pubertal period of ontogenesis. Finally, the models providing comprehensive molecular insights into ex situ-protected porcine BM- and AT -derived MSCs and their differentiated derivatives can be largely suitable for the biotechnologically assisted rescue and restitution of endangered representatives of rare native breeds of domestic pig.

Comparison of perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section

Objective To compare the perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section. Methods A retrospective analysis of 6 years of data was performed. Exclusions were cases with gestational ages <24 weeks, placenta accreta spectrum, polyhydramnios, or multiple gestations. Results The study included 494 patients whose body mass index (BMI) exceeded 40 kg/m2 at delivery. Of these, 469 were morbidly obese (BMI 40–49.9; mean, 42.9 ± 2.4), and 25 were super obese (BMI >50; mean, 54.5 ± 4.2). Twenty-four (5.1%) morbidly obese women received general anesthesia. The other 445 patients (94.9%) in the morbid obesity group underwent cesarean delivery under regional anesthesia; however, some (2.2%; 10/445) received general anesthesia after regional anesthesia failed. In the super-obesity group, 23 patients (92.0%) received regional anesthesia, while two patients (8.0%) received general anesthesia. There were no cases of pulmonary aspiration, maternal deaths, or difficult or failed intubation. There was one episode of cardiac arrest in a patient with a BMI of 47.9. Among the morbidly obese and super-obese women given regional anesthesia, the super-obese patients had significantly greater volumes of ephedrine and norepinephrine consumption (p = 0.027 and 0.030), intravenous fluids (p = 0.006), and bleeding during surgery (p = 0.017). They also had more hypotensive episodes (p = 0.038). The two groups’ incidences of neonatal birth asphyxia, postpartum hemorrhage, blood transfusion, and uterine atony did not differ significantly. The lengths of stay in the hospital were also comparable. Conclusions Among the women receiving regional anesthesia, the super-obese parturients had greater intraoperative bleeding, a higher proportion of hypotensive episodes, and a greater vasopressor requirement than the morbidly obese parturients. Anesthesiologists must prepare for the adverse perioperative events that such women risk experiencing during a delivery by cesarean section. Trial registration www.clinicaltrials.gov ID: NCT04657692.

Skin Incision Selection in Superobese Women Undergoing Cesarean Birth.

The aim of this study was to examine whether vertical versus transverse skin incision is associated with increased wound complications in superobese women undergoing cesarean. This is a secondary analysis of a retrospective cohort study that included women with a body mass index (BMI) ≥ 50 kg/m2 and a cesarean birth with documented skin incision type from 1/1/2008 to 12/31/2015 at a single academic medical center. The primary outcome was a composite of wound complications: infection requiring antibiotics including superficial cellulitis, deep and organ space infections requiring packing, vacuum placement or exploration and debridement in the operating room. Secondary outcomes included estimated blood loss (EBL), time from skin incision to delivery, need for classical or T-hysterotomy, prolonged hospital admission (>4 days), and a composite of adverse neonatal outcomes. The primary exposure was skin incision type, transverse or vertical. Modified Poisson regression variance was used to adjust for differences in baseline characteristics. During the study period, 298 women underwent a cesarean with a known skin incision type. Vertical skin incision occurred in 25.8%. Women with a vertical skin incision were younger, had a higher BMI at delivery, had less weight gain in pregnancy, and were less likely to have labored prior to cesarean. Wound complications were not significantly more common in women with a vertical skin incision after adjusting for covariates (vertical 48.1 vs. transverse 29.4%, adjusted relative risk (aRR): 1.31, 95% confidence interval [CI]: 0.92-1.86). Compared with a transverse skin incision, vertical skin incision was associated with an increased risk for classical hysterotomy (67 vs. 17%, aRR: 2.96, 95% CI: 2.12-4.14), higher EBL, prolonged hospital stay, and composite neonatal morbidity. There were no statistically significant differences in the time from skin incision to delivery. In superobese women, vertical skin incision was not associated with increased wound complications, but was associated with increased risk for classical hysterotomy. · Vertical skin incision was not associated with a higher risk for composite wound morbidity after adjusting for covariates.. · Vertical skin incision was significantly associated with classical hysterotomy without associated decrease in incision to delivery time or neonatal morbidity.. · When selecting a skin incision approach in superobese women, clinicians should consider whether potential benefits outweigh known risks..

Severe maternal morbidity and mortality during delivery hospitalization of class I, II, III, and super obese women

Previous studies show that obesity predisposes patients to higher risks of adverse pregnancy outcomes. Data on the relationship between increasing degrees of obesity and risks of severe maternal morbidity, including mortality, are limited. We examined the association of increasing classes of obesity, especially super obesity, with the risk of severe maternal morbidity and mortality at the time of delivery hospitalization. Using New York City linked birth certificates and hospital discharge data, we conducted a retrospective cohort study. This study identified delivery hospitalizations for singleton, live births in 2008-2012. Women were classified as having obesity (class I, II, III, or super obesity), as opposed to normal weight or overweight, based on prepregnancy body mass index. Cases of severe maternal morbidity were identified based on International Classification of Diseases, Ninth Revision diagnosis and procedure codes according to Centers for Disease Control and Prevention criteria. Multivariable logistic regression was used to evaluate the association between obesity classes and severe maternal morbidity, adjusting for maternal sociodemographic characteristics. During 2008-2012, there were 570,997 live singleton births with available information on prepregnancy body mass index that met all inclusion criteria. After adjusting for maternal characteristics, women with class II (adjusted odds ratio, 1.14; 95% confidence interval, 1.05-1.23), class III (adjusted odds ratio, 1.34; 95% confidence interval, 1.21-1.49), and super obesity (adjusted odds ratio, 1.99; 95% confidence interval, 1.57-2.54) were all significantly more likely to have severe maternal morbidity than normal and overweight women. Super obesity was associated with specific severe maternal morbidity indicators, including renal failure, air and thrombotic embolism, blood transfusion, heart failure, and the need for mechanical ventilation. There is a significant dose-response relationship between increasing obesity class and the risk of severe maternal morbidity at delivery hospitalization. The risks of severe maternal morbidity are highest for women with super obesity. Given that this is a modifiable risk factor, women with prepregnancy obesity should be counseled on the specific risks associated with pregnancy before conception to optimize their pregnancy outcomes.

Neuraxial labor analgesia failure rates in women with a body mass index ≥50 kg/m2: a single-center retrospective study

BackgroundThe failure rate of neuraxial labor analgesia has not been investigated in super-obese women (body mass index ≥50 kg/m2). MethodsWe performed a retrospective study of neuraxial labor analgesia in super-obese women (January 2012 to August 2019). The primary outcome was the failure rate of the first neuraxial catheter. Secondary outcomes were failure rates by neuraxial technique, at cesarean delivery, and rate of catheter replacement. ResultsNeuraxial labor analgesia was used by 233 super-obese women: 153 epidural catheters placed using a combined spinal-epidural (CSE) or dural puncture epidural techniques with visualization of cerebrospinal fluid; 63 placed without dural puncture (including procedures without attempted dural puncture or attempted CSE or dural puncture epidural); and 17 intrathecal catheters (seven intentional). Thirty-two of 233 neuraxial catheters failed (13.7%, 95% Confidence Interval [CI] 9.9 to 18.7%). Epidural catheters placed using CSE or dural puncture epidural had a lower failure rate than those placed without dural puncture (9.2%, 95% CI 5.5% to 14.7%) vs 28.6% (95% CI 18.9% to 40.7%; P<0.001). Catheter migration was documented for 29.4% (95% CI 16.8 to 46.2%) of catheters that failed. ConclusionsEpidural catheters placed using CSE or dural puncture epidural techniques were more reliable than those placed without dural puncture in super-obese parturients. It is unclear whether the result was driven by grouping procedures without attempted dural puncture with those in which dural puncture was attempted but cerebrospinal fluid was not obtained. Catheter migration was a major source of failure.

767 Cesarean wound outcomes among super obese women

To evaluate the difference in wound outcomes among super obese (BMI >50 kg/m2) and obese (BMI 30-49.9 kg/m2) women undergoing cesarean delivery. This is a secondary analysis of a single site randomized clinical trial of women who underwent cesarean delivery between September 2013 and June 2016. Participants in the original study were randomized to a silver nylon dressing versus standard gauze dressing. Inclusion criteria included completion of > 36 gestational weeks, receipt of preoperative antibiotics, and scheduled or unscheduled cesarean delivery via Pfannenstiel incision. In this secondary analysis, patient characteristic of women with BMI >50 kg/m2 were compared to women with BMI 30-49.9 kg/m2 using chi-square, Students T-test, and logistic regression to generate adjusted odds ratios and 95% confidence intervals. P-value < 0.5 was considered significant. Among the 657 participants who underwent randomization, 470 were noted to have BMI >30 kg/m2. Within this cohort of obese women, 50 (10.6%) had a BMI >50 kg/m2. Sociodemographic data was similar among the groups. Women in the obese and super obese groups were similar with regard to labor prior to cesarean (30.8% vs 38.8%, p=0.255), smoking status in pregnancy (6.2% vs 0%, p=0.18), chorioamnionitis (3.3% vs 6.0%, p=0.34), and diabetes type 1 (2.1% vs 2.0%, p=0.947). Compared to women BMI 30-49.9 kg/m2, super obese women had higher rates of gestational diabetes (22% vs 8.1%, p< 0.001), diabetes type 2 (14% vs 5%, p=0.011), chronic hypertension (52% vs 15.7%, p< 0.001), and prior cesarean delivery (26.5% vs 12.6%, p=0.008). Women in the super obese category were more likely to have any wound infection (aOR 2.95 [1.14-7.62]). Composite outcome for wound complication was not statistically significantly increased for the super obese cohort (aOR 1.7 [0.73-4.09]). History of prior cesarean delivery was independently associated with increased risk of wound infection. Women with BMI > 50 kg/m2 undergoing cesarean delivery were more likely to have a wound infection compared to obese counterparts.

628 Obstetric and neonatal outcomes stratified by higher levels of superobesity

Maternal superobesity (body mass index [BMI] ≥50) is increasing in the United States. However, there is limited data describing neonatal outcomes with stratification higher than a body mass index (BMI) >50. The objective of this study was to determine if there is a dose dependent increase in obstetric and neonatal adverse outcomes at higher levels of BMI in superobese women. This is a retrospective cohort study of obese pregnant women with singleton gestations who delivered at a single academic institution between 2000-2019 with BMI at delivery and neonatal outcomes available for analysis. Superobese women were stratified by BMI 50-59.9, 60-69.9, and ≥70 at time of delivery. Multivariate logistic regression was performed to calculate adjusted odds ratios (aOR) for individual obstetric and composite neonatal outcomes comparing higher levels of superobesity as well as overall superobesity compared to women with class I obesity (BMI 30-34.9). 12,373 pregnant women were included in the study. Of these women, 1,470 were superobese (1,184 with BMI 50-59.9, 230 with BMI 60-69.9 and 56 with BMI ≥70). When compared to class I obese parturients, superobese women were more likely to have higher baseline co-morbid illness (Table 1). Overall, superobese women had a higher probability of obstetric complications including preeclampsia (aOR 2.66; CI 2.29-3.09), preterm birth (aOR 1.26; CI 1.10-1.43), and cesarean delivery (aOR 3.02; CI 2.69-3.39). Neonates of superobese women were more likely to be LGA (aOR 2.01; CI 1.72-2.34), have an Apgar <7 at 5 minutes (aOR 1.54; CI 1.27-1.86), and experience mild (aOR 1.72; CI 1.52-1.94), but not severe (aOR 0.91; CI 0.73-1.11), composite neonatal morbidity. No significant differences were found for the studied outcomes when superobesity was further stratified above BMI>50 (Table 2). Compared to their less obese counterparts, superobese pregnant women are at increased risk of adverse obstetric and neonatal outcomes. However, there does not appear to be additional risk with higher stratified levels of BMI >50 in women with superobesity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

626 Risk of maternal peripartum complications by mode of delivery among patients with superobesity

Superobesity (pre-pregnancy body mass index (BMI) >=50 kg/m2) is increasingly common in the United States. Little is known about the effect of superobesity on maternal peripartum complications. We sought to determine whether superobesity is a risk factor for maternal peripartum morbidity based on mode of delivery. The 2016-18 National Center for Health Statistics natality data was queried for delivery hospitalizations 20-44 weeks gestation linked to patients with superobesity. The primary outcome was a maternal peripartum morbidity composite comprised of unplanned hysterectomy, maternal intensive care unit (ICU) admission, transfusion, and eclampsia. Composite risk was analyzed using log linear regression modeling with the primary exposure of superobesity stratified by delivery mode of vaginal delivery (VD), operative vaginal delivery (OVD), and cesarean delivery (CD) and adjusting for maternal parity, race, age, payer, and medical factors (chorioamnionitis, pregestational and gestational diabetes, chronic and gestational hypertension). Of 11.2 million delivery hospitalizations, 354,350 were linked to women with superobesity. Compared to women of normal BMI, superobese women had a lower rate of VD (58.9% v. 70.4%) and OVD (2.4% v. 3.7%) and a higher rate of primary (22.1% v. 15.8%) and repeat cesarean delivery (16.7% v. 10.0%). The incidence of maternal peripartum complications was higher for superobese women and generally increased with higher BMI (Figure). In adjusted analyses, superobese women were 33% (aRR 1.33, 95% CI: 1.29, 1.39) more likely to experience maternal peripartum complications overall and at higher risk of complications for all modes of delivery compared to patients with normal weight (Table). Women with superobesity are at higher risk of peripartum maternal morbidity including unplanned hysterectomy, ICU admission, transfusion and eclampsia in all modes of delivery. These findings highlight superobesity as an independent risk factor for maternal morbidity regardless of mode of delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Surgical outcomes of superobese women treated for endometrial intraepithelial neoplasia and endometrial cancer

Surgical outcomes of superobese women treated for endometrial intraepithelial neoplasia and endometrial cancer

Severe Maternal Morbidity and Mortality During Delivery Hospitalization of Class I, II, III, and Super Obese Women [39I

INTRODUCTION: Previous studies show that obesity predisposes patients to higher risks of adverse pregnancy outcomes. Data on the relationship between increasing degrees of obesity and risks of severe maternal morbidity, including mortality (SMM), are limited. The purpose of this study was to examine the association of different classes of obesity with SMM during delivery hospitalization. METHODS: Using New York City linked birth certificates and hospital discharge data, this study identified delivery hospitalizations for singleton, live births from 2008 through 2012. Women were classified as obese (Class I, II, III or super obesity), as opposed to normal weight or overweight, based on pre-pregnancy body mass index (BMI). Cases of SMM were identified based on ICD-9 diagnosis and procedure codes according to CDC criteria. Multivariable logistic regression was used to evaluate the association between obesity classes and SMM, adjusting for maternal socio-demographic and medical comorbidities. RESULTS: There were 539,870 live singleton births with available information on pre-pregnancy BMI. After adjusting for maternal characteristics, women with Class I (adjusted odds ratio (aOR) 1.07; 95% confidence interval (CI) 1.02-1.13), Class II (1.13; 1.05-1.21), Class III (1.26; 1.15-1.38), and super obesity (1.68; 1.32-2.11) were all significantly more likely to have SMM compared to normal and overweight women. Increasing BMI was associated with specific SMM indicators including: renal failure, blood transfusion, and heart failure in the adjusted analysis. CONCLUSION: There is a significant dose-response relationship between increasing obesity class and risk of SMM at delivery hospitalization. This relationship persisted even after accounting for potential confounding effects of comorbid conditions.

544: Skin incision in superobese women undergoing cesarean delivery

To examine whether a vertical versus transverse skin incision is associated with increased wound complications in superobese women undergoing cesarean delivery (CD). We conducted a retrospective cohort study of all women with a BMI at delivery of >=50 between 1/1/2010 - 12/31/2015. All women undergoing CD at >=24 weeks with data regarding incision type were included for analysis. The primary outcome was wound complication defined as the need for antibiotics, wound packing/vacuum, or surgical exploration. Secondary outcomes included estimated blood loss (EBL) during CD, time from skin incision to delivery, need for classical hysterotomy, endometritis, prolonged admission (>4 days), and a composite of neonatal morbidities. Logisitic regression was performed to adjust for differences in baseline characteristics. 427 women delivered during the study period with a BMI >=50, 300 underwent a CD and 2 had data missing regarding skin incision. The final analysis included 298 women, of whom 77 (26%) had a vertical skin incision. Women with a vertical incision were older, had a higher BMI (58.7 IQR 53.8-62.8 vs 53.2 IQR 51.2-56.0), were more likely to be African-American, and less likely to have labored prior to delivery. There were no differences in medical comorbidities, smoking status, gestational age at delivery, need for emergent delivery, or number of prior cesareans. Women with a vertical incision had higher blood loss at delivery (900cc IQR 800-1200 vs 800cc IQR 700-1000, p=0.008), increased wound complications, and were more likely to require a classical hysterotomy, have a prolonged length of stay, and greater composite neonatal morbidity. There were no difference in incision to delivery times between vertical and transverse skins (17.5 IQR12.0-25.0 vs 18.0 IQR 13.0-26.0, p=0.83). After adjusting for potential confounders, vertical incision was no longer associated with wound complications or composite neonatal morbidity, however it remained significantly associated with classical hysterotomy (aOR 6.42, 95% CI 3.36-12.27) and prolonged admission (aOR 5.39, 95% CI 1.98-14.72). In superobese women, vertical skin incision is not associated with decreased wound complications, however this approach is associated with an increased risk for classical hysterotomy without decreasing neonatal morbidity or incision to delivery time.

Body Mass Index 50 kg/m2 and Beyond: Perioperative Care of Pregnant Women With Superobesity Undergoing Cesarean Delivery.

Superobesity, defined as body mass index 50 kg/m2 or greater, is the fastest-growing obesity group in the United States. Currently, 2% of pregnant women in the United States are superobese, and 50% will deliver via cesarean delivery. To review evidence of perioperative care during cesarean delivery among superobese women. We performed an evidence-based review of maternal and neonatal risks of cesarean delivery and of intraoperative management and immediate postpartum care of superobese pregnant women. We also reviewed bariatric and general literature surgery on perioperative care of superobese patients. There is limited information to direct evidence-based care of superobese women who undergo cesarean delivery. Superobese women have a 30% to 50% risk of wound complications, a 20% risk of neonatal intensive care unit admission, and a 1% to 2% risk of maternal intensive care unit admission. Preoperative discussion with superobese women should include a review of maternal and fetal risks associated with cesarean delivery, as well as operative options including skin incision. Preoperative cefazolin with a 3-g dose, chlorhexidine skin preparation, and availability of adequate personnel for patient transfers are important evidence-directed approaches to reducing maternal and personnel morbidity. Postoperatively, early ambulation and chemical prophylaxis are reasonable, although there is a lack of evidence as to whether these measures prevent thromboembolic complications. Superobese women are at increased risk of cesarean delivery and resultant complications. Most evidence-directed recommendations for perioperative care are extrapolated from studies of obese women undergoing bariatric surgery. As the prevalence of reproductive-age women with superobesity increases, studies directed at this high-risk population are urgently need.

Goldilocks Mastectomy: A Safe Bridge to Implant-Based Breast Reconstruction in the Morbidly Obese.

Background:Reconstructive surgeons are encountering an increasing number of obese women requiring postmastectomy reconstruction. These patients are poor candidates for autologous and prosthetic-based reconstructions as they have a high rate of reconstructive failure, surgical complications, and poor aesthetic outcomes. We demonstrate here the utility of the previously described Goldilocks mastectomy with free nipple grafts as a safe bridge to second stage implant-based breast reconstruction.Methods:Ten consecutive morbidly (BMI > 40) or super obese (BMI>50) women underwent bilateral Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral implant placement at least three months postoperatively. Patients were assessed for implant-related complications including malposition, capsular contracture, dehiscence, and extrusion.Results:Ten postmastectomy reconstructions in patients with BMIs ranging from 37 to 50 with a mean BMI of 45 underwent bilateral Goldilocks mastectomy with free nipple grafts. Two patients had wound healing complications after Goldilocks mastectomy but were completely healed within 8 weeks. There were no instances of delayed wound healing or reconstructive failure after prosthetic placement. With at least 9 months of follow-up on all patients, no patient has had a capsular contracture, significant malposition, or other complication requiring reoperation.Conclusion:The obese patient poses a significant reconstructive challenge for which no reproducible approach has been described. Here, we present a 2-stage strategy: the previously described Goldilocks mastectomy with free nipple grafts followed by second stage subpectoral definitive implant placement. This is the first proposed description of a reliable strategy for postmastectomy reconstruction in the morbidly and super obese.

Associations between maternal size and health outcomes for women undergoing caesarean section: a multicentre prospective observational study (The MUM SIZE Study)

ObjectivesTo investigate associations between maternal body mass index (BMI) at delivery (using pregnancy-specific BMI cut-off values 5 kg/m2 higher in each of the WHO groups) and clinical, theatre utilisation and...

Maternal super obesity and risk for intensive care unit admission in the MFMU Cesarean Registry.

Obesity is a risk factor for intensive care unit (ICU) admission in nonpregnant populations. Less is known about maternal obesity and ICU admission risk. The objective of this study was to estimate the association between maternal obesity and ICU admission among women who delivered via cesarean section or vaginal birth after cesarean section (VBAC). This is a retrospective cohort analysis of women who delivered via VBAC or cesarean section in the Maternal-Fetal Medicine Unit (MFMU) Cesarean Registry. We defined exposure as body mass index (BMI) at delivery stratified as non-obese (BMI 18.5-29.9 kg/m2 ), class I or II obese (BMI 30-39.9 kg/m2 ), morbidly obese (BMI 40-49.9 kg/m2 ), and super obese (BMI ≥ 50 kg/m2 ). The primary outcome was ICU admission. Modified Poisson regression models estimated relative risk (RR) of ICU admission by obesity strata, after adjusting for confounders. Mediation analysis was used to estimate the proportion of ICU admission risk attributable specifically to obesity. We included 68 455 women; 40% non-obese, 46% class I or II obese, 12% morbidly obese, and 2% super obese. Super obese women were at higher risk for ICU admission compared with non-obese women (0.7 vs. 1.3%, adjusted RR 1.61; 95% CI 1.01-2.65), after adjusting for confounders. Among super obese women, medical comorbidities mediated 58% of ICU admission risk, suggesting that a significant proportion of ICU admission is driven by maternal obesity. Super obese women who deliver by cesarean section or VBAC are at increased risk of peripartum ICU admission. Obstetricians and critical care specialists should consider possible ICU admission during delivery planning.

Maternal obesity and major intraoperative complications during cesarean delivery

Multiple studies have demonstrated an association between maternal obesity and postoperative complications, but there is a dearth of information about the impact of obesity on intraoperative complications. To estimate the association between maternal obesity at delivery and major intraoperative complications during cesarean delivery (CD). This is a secondary analysis of the deidentified Maternal-Fetal Medicine Unit Cesarean Registry of women with singleton pregnancies. Maternal body mass index (BMI) at delivery was categorized as BMI 18.5 to 29.9 kg/m2, BMI 30 to 39.9 kg/m2, BMI 40 to 49.9 kg/m2, and BMI ≥ 50 kg/m2. The primary outcome, any intraoperative complication, was defined as having at least 1 major intraoperative complication, including perioperative blood transfusion, intraoperative injury (bowel, bladder, ureteral injury; broad ligament hematoma), atony requiring surgical intervention, repeat laparotomy, and hysterectomy. Log-binomial models were used to estimate risk ratios of intraoperative complication in 2 models: model 1 adjusting for maternal race, and preterm delivery <37 weeks; and model 2 adjusting for confounders in Model 1 as well as emergency CD, and type of skin incision. A total of 51,218 women underwent CD; 38% had BMI 18.5 to 29.9 kg/m2, 47% BMI 30 to 39.9 kg/m2, 12% BMI 40 to 49.9 kg/m2 and 3% BMI ≥ 50 kg/m2. Having at least 1 intraoperative complication was uncommon (3.4%): 3.8% for BMI 18.5 to 29.9 kg/m2, 3.2% BMI 30 to 39.9 kg/m2, 2.6% BMI 40 to 49.9 kg/m2 and 4.3% BMI ≥ 50 kg/m2 (P < .001). In the fully adjusted model 2, women with BMI 40 to 49.9 kg/m2 had a lower risk of any intraoperative complication (adjusted risk ratio [ARR], 0.76; 95% confidence interval [CI], 0.64 to 0.89) compared with women with BMI 18.5 to 29.9 kg/m2. Women with BMI 30 to 39.9 kg/m2 (ARR, 0.93; 95% CI, 0.84 to 1.03) had a similar risk of any intraoperative complication compared with nonobese women. Among super obese women, there was evidence of effect modification by emergency CD. Compared with nonobese women, neither super obese women undergoing nonemergency CD (ARR, 1.13; 95% CI, 0.84 to 1.52) nor those undergoing emergency CD (ARR, 0.59; 95% CI, 0.32 to 1.10) had an increased risk of intraoperative complication. In contrast to the risk for postcesarean complications, the risk of intraoperative complication does not appear to be increased in obese women, even among those with super obesity.

Maternal Super Obesity and Neonatal Morbidity after Term Cesarean Delivery.

Objective To estimate the association between maternal super obesity (body mass index [BMI] ≥ 50 kg/m(2)) and neonatal morbidity among neonates born via cesarean delivery (CD). Methods Retrospective cohort of singleton neonates delivered via CD ≥ 37 weeks in the Maternal-Fetal Medicine Unit Cesarean Registry. Maternal BMI at delivery was stratified as 18.5 to 29.9 kg/m(2), 30 to 39.9 kg/m(2), 40 to 49.9 kg/m(2), and ≥ 50 kg/m(2). Primary outcomes included acute (5-minute Apgar score < 5, cardiopulmonary resuscitation and ventilator support < 24 hours, neonatal injury, and/or transient tachypnea of the newborn) and severe (grade 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, seizure, respiratory distress syndrome, hypoxic ischemic encephalopathy, meconium aspiration, ventilator support ≥ 2 days, sepsis and/or neonatal death) neonatal morbidity. Odds of neonatal morbidity were estimated for each BMI category adjusting for clinical and operative characteristics. Results Of 41,262 maternal-neonatal dyads, 36% of women were nonobese, 49% had BMI of 30 to 39.9 kg/m(2), 12% had BMI of 40 to 49.9 kg/m(2), and 3% were super obese. Compared with nonobese women, super obese women had twofold odds of acute (5 vs. 10%; adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.59-2.73) and severe (3 vs. 6%; aOR: 2.08; 95% CI: 1.59-2.73) neonatal morbidity. Conclusion Among term infants delivered via CD, maternal super obesity is associated with increased risk of neonatal morbidity.

Morbidly obese and super-obese women should have surgery refused for benign conditions: FOR: A holistic approach is required to tackle the obesity pandemic and its effects.

Morbidly obese and super-obese women should have surgery refused for benign conditions: FOR: A holistic approach is required to tackle the obesity pandemic and its effects.

Morbidly obese and super-obese women should have surgery refused for benign conditions: AGAINST: Refusing surgery is both legally and morally wrong.

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Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study.

BackgroundSuper-obesity is associated with significantly elevated rates of obstetric complications, adverse perinatal outcomes and interventions. The purpose of this study was to determine the prevalence, risk factors, management and perinatal outcomes of super-obese women giving birth in Australia.MethodsA national population-based cohort study. Super-obese pregnant women (body mass index (BMI) >50 kg/m2 or weight >140 kg) who gave birth between January 1 and October 31, 2010 and a comparison cohort were identified using the Australasian Maternity Outcomes Surveillance System (AMOSS). Outcomes included maternal and perinatal morbidity and mortality. Prevalence estimates calculated with 95 % confidence intervals (CIs). Adjusted odds ratios (ORs) were calculated using multivariable logistic regression.Results370 super-obese women with a median BMI of 52.8 kg/m2 (range 40.9–79.9 kg/m2) and prevalence of 2.1 per 1 000 women giving birth (95 % CI: 1.96–2.40). Super-obese women were significantly more likely to be public patients (96.2 %), smoke (23.8 %) and be socio-economically disadvantaged (36.2 %). Compared with other women, super-obese women had a significantly higher risk for obstetric (adjusted odds ratio (AOR) 2.42, 95 % CI: 1.77–3.29) and medical (AOR: 2.89, 95 % CI: 2.64–4.11) complications during pregnancy, birth by caesarean section (51.6 %) and admission to special care (HDU/ICU) (6.2 %). The 372 babies born to 365 super-obese women with outcomes known had significantly higher rates of birthweight ≥4500 g (AOR 19.94, 95 % CI: 6.81–58.36), hospital transfer (AOR 3.81, 95 % CI: 1.93–7.55) and admission to Neonatal Intensive Care Unit (NICU) (AOR 1.83, 95 % CI: 1.27–2.65) compared to babies of the comparison group, but not prematurity (10.5 % versus 9.2 %) or perinatal mortality (11.0 (95 % CI: 4.3–28.0) versus 6.6 (95 % CI: 2.6- 16.8) per 1 000 singleton births).ConclusionsSuper-obesity in pregnancy in Australia is associated with increased rates of pregnancy and birth complications, and with social disadvantage. There is an urgent need to further address risk factors leading to super-obesity among pregnant women and for maternity services to better address pre-pregnancy and pregnancy care to reduce associated inequalities in perinatal outcomes.