Download PDF
Am J Perinatol 2009; 26(5): 345-349
DOI: 10.1055/s-0028-1110084
© Thieme Medical Publishers

The Impact of Maternal Obesity on the Incidence of Adverse Pregnancy Outcomes in High-Risk Term Pregnancies

Saju Joy1 , Niki Istwan2 , Debbie Rhea2 , Cheryl Desch2 , Gary Stanziano2
  • 1Wake Forest University, Winston-Salem, North Carolina
  • 2Matria Healthcare, Department of Clinical Research, Marietta, Georgia
Further Information

Publication History

Publication Date:
09 December 2008 (online)

Also available at
    Permissions and Reprints

ABSTRACT

We investigated the impact of maternal obesity on pregnancy outcomes. Women with normal or obese body mass index (BMI) who delivered singleton infants at term were identified from a perinatal database. Rates of pregnancy complications and neonatal outcomes were compared between women with normal prepregnancy BMI (20 to 24.9 kg/m2, n = 9171) and those with an obese prepregnancy BMI (≥ 30, n = 3744). Rates of pregnancy complications and neonatal outcomes were also evaluated by the level of obesity (obese [30 to 34.9 kg/m2, n = 2106], severe obesity [35 to 39.9 kg/m2, n = 953], and morbid obesity [≥ 40 kg/m2, n = 685]). Rates of gestational diabetes (12.0% versus 3.7%, p < 0.001, odds ratio [95% confidence interval] = 3.5 [3.0, 4.1]) and gestational hypertension (30.9% versus 9.0%, p < 0.001, odds ratio [95% confidence interval] = 4.5 [4.1, 5.0]) were higher for obese versus normal BMI gravidas, respectively. Women with morbid or severe obesity had a greater incidence of gestational diabetes than women with an obese (30 to 34.9 kg/m2) or normal BMI (14.1%, 16.4%, 9.6%, and 3.7%, respectively; p < 0.05). The incidence of gestational hypertension increased with maternal BMI (9.0% normal, 25.5% obese, 33.7% severe, 43.4% morbid; all pairwise comparisons p < 0.05). Obese versus normal BMI was associated with more higher-level nursery admissions (8.2% versus 5.8%) and large-for-gestational age infants (12.3% versus 6.5%; p < 0.001). Obesity places a term pregnancy at risk for adverse maternal and neonatal outcomes.

KEYWORDS

Maternal obesity - body mass index - pregnancy outcomes - neonatal outcomes

REFERENCES

  • 1 American College of Obstetricians and Gynecologists . ACOG Committee Opinion No. 315. Obesity in pregnancy.  Obstet Gynecol. 2005;  106 671-675
    PubMedSearch in Google Scholar
  • 2 The Clinical Guidelines on the Identification .Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. NIH Publication No. 98–4083, September 1998, produced by the National Heart, Lung, and Blood Institute in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases Available at: http://www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/txgd/40.htm
  • 3 Mighty H E, Fahey A J. Obesity and pregnancy complications.  Curr Diab Rep. 2007;  7 289-294
    CrossrefPubMedSearch in Google Scholar
  • 4 Doherty D A, Magann E F, Francis J et al.. Pre-pregnancy body mass index and pregnancy outcomes.  Int J Gynaecol Obstet. 2006;  95 242-247
    CrossrefPubMedSearch in Google Scholar
  • 5 Kristensen J, Vestergaard M, Wisborg K et al.. Pre-pregnancy weight and the risk of stillbirth and neonatal death.  BJOG. 2005;  112 403-408
    CrossrefPubMedSearch in Google Scholar
  • 6 Cedergren M I. Maternal morbid obesity and the risk of adverse pregnancy outcome.  Obstet Gynecol. 2004;  103 219-224
    CrossrefPubMedSearch in Google Scholar
  • 7 Kiel D W, Dodson E A, Artal R, Boehmer T K, Leet T L. Gestational weight gain and pregnancy outcomes in obese women: how much is enough?.  Obstet Gynecol. 2007;  110 752-758
    CrossrefPubMedSearch in Google Scholar
  • 8 Weiss J L, Malone F D, Emig D et al.. Obesity, obstetric complications and cesarean delivery rate—a population-based screening study.  Am J Obstet Gynecol. 2004;  190 1091-1097
    CrossrefPubMedSearch in Google Scholar
  • 9 Chu S Y, Kim S Y, Lau J et al.. Maternal obesity and risk of stillbirth: a meta-analysis.  Am J Obstet Gynecol. 2007;  197 223-228
    CrossrefPubMedSearch in Google Scholar
  • 10 Chu S Y, Kim S Y, Schmid C H et al.. Maternal obesity and risk of cesarean delivery: a meta-analysis.  Obes Rev. 2007;  8 385-394
    CrossrefPubMedSearch in Google Scholar
  • 11 Chu S Y, Callaghan W M, Kim S Y et al.. Maternal obesity and risk of gestational diabetes mellitus.  Diabetes Care. 2007;  30 2070-2076
    CrossrefPubMedSearch in Google Scholar
  • 12 Schmitt N M, Nicholson W K, Schmitt J. The association of pregnancy and the development of obesity—results of a systematic review and meta-analysis on the natural history of postpartum weight retention.  Int J Obes (Lond). 2007;  31 1642-1651
    CrossrefPubMedSearch in Google Scholar
  • 13 Chu S Y, Bachman D J, Callaghan W M et al.. Association between obesity during pregnancy and increased use of health care.  N Engl J Med. 2008;  358 1444-1453
    CrossrefPubMedSearch in Google Scholar
  • 14 Nathanielsz P W, Poston L, Taylor P D. In-utero exposure to maternal obesity and diabetes: animal models that identify and characterize implications for future health.  Clin Perinatol. 2007;  34 515-526
    PubMedSearch in Google Scholar
  • 15 Kiran U, Evans J. Poor uterine contractility in obese women.  BJOG. 2007;  114 1304-1305
    PubMedSearch in Google Scholar
  • 16 Zhang J, Bricker L, Wray S, Quenby S. Poor uterine contractility in obese women.  BJOG. 2007;  114 343-348
    CrossrefPubMedSearch in Google Scholar
  • 17 Bodnar L M, Catov J M, Roberts J M, Simhan H N. Prepregnancy obesity predicts poor vitamin D status in mothers and their neonates.  J Nutr. 2007;  137 2437-2442
    PubMedSearch in Google Scholar

Saju JoyM.D. M.S. 

Wake Forest University Health Sciences, Department of OB/GYN

Maternal-Fetal Medicine, Medical Center Boulevard, Winston-Salem, NC 27157

Email: sjoy@wfubmc.edu