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Am J Perinatol 2019; 36(10): 1023-1030
DOI: 10.1055/s-0038-1675624
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Gestational Weight Gain on Trial of Labor after Cesarean Success

Jenny Y. Mei
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California
,
Alexandra L. Havard
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California
,
Amanda J. Mularz
2   Obstetrix Medical Group of Houston, Houston, Texas
,
Melanie M. Maykin
3   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
,
Stephanie L. Gaw
3   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
› Author Affiliations
Further Information

Publication History

25 June 2018

20 September 2018

Publication Date:
30 November 2018 (online)

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Abstract

Objective Excessive gestational weight gain (GWG) has been associated with adverse pregnancy outcomes, including increased risk of cesarean delivery (CD). Data are limited on associations between GWG and outcomes in women undergoing trial of labor after cesarean (TOLAC). We aimed to investigate whether appropriate GWG impacts TOLAC outcomes.

Study Design We performed a retrospective cohort study of women undergoing TOLAC at a single institution from May 2007 to April 2016. Women were divided into three groups based on GWG as compared with the Institute of Medicine recommendations. The primary outcome was successful vaginal birth after cesarean (VBAC). Secondary outcomes included various perinatal morbidity markers.

Results A total of 614 women underwent TOLAC, of whom 444 (72.3%) had successful VBACs. When grouped by GWG in accordance with the Institute of Medicine guidelines, 149 (24.3%) women had GWG below guidelines, 224 (36.5%) met guidelines, and 241(39.3%) exceeded guidelines. There was no difference in the rate of VBAC success among the three groups. We also found no differences in secondary perinatal morbidity markers.

Conclusion We found no difference in TOLAC success rates with excess GWG. Providers should not consider excess GWG a risk factor for failed TOLAC, even in obese patients.

Keywords

vaginal birth after cesarean - gestational weight gain - obesity

Note

This study was presented in part in poster format at the Annual Clinical and Scientific Meeting of the American Congress of Obstetricians and Gynecologists, May 6–9, 2017, San Diego, CA.


 

  • References

  • 1 Hall MJ, DeFrances CJ, Williams SN. , et al. National hospital discharge survey: 2007 summary. Natl Health Stat Report 2010; 29: 1-20
    PubMedSearch in Google Scholar
  • 2 Martin JA, Hamilton BE, Menacker F, Sutton PD, Mathews TJ. . Preliminary births for 2004: infant and maternal health. Health E-stats. Hyattsville, MD: National Center for Health Statistics; 2005
    PubMed
  • 3 Cunningham FG, Bangdiwala SI, Brown SS. , et al. NIH consensus development conference draft statement on vaginal birth after cesarean: new insights. NIH Consens State Sci Statements 2010; 27 (03) 1-42
    PubMedSearch in Google Scholar
  • 4 Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 184: vaginal birth after cesarean delivery. Obstet Gynecol 2017; 130 (05) e217-e233
    CrossrefPubMedSearch in Google Scholar
  • 5 Zhang J, Troendle J, Reddy UM. , et al; Consortium on Safe Labor. Contemporary cesarean delivery practice in the United States. Am J Obstet Gynecol 2010; 203 (04) 326.e1-326.e10
    CrossrefPubMedSearch in Google Scholar
  • 6 Guise JM, Denman MA, Emeis C. , et al. Vaginal birth after cesarean: new insights on maternal and neonatal outcomes. Obstet Gynecol 2010; 115 (06) 1267-1278
    CrossrefPubMedSearch in Google Scholar
  • 7 Juhasz G, Gyamfi C, Gyamfi P, Tocce K, Stone JL. Effect of body mass index and excessive weight gain on success of vaginal birth after cesarean delivery. Obstet Gynecol 2005; 106 (04) 741-746
    CrossrefPubMedSearch in Google Scholar
  • 8 Carroll Sr CS, Magann EF, Chauhan SP, Klauser CK, Morrison JC. Vaginal birth after cesarean section versus elective repeat cesarean delivery: Weight-based outcomes. Am J Obstet Gynecol 2003; 188 (06) 1516-1520
    CrossrefPubMedSearch in Google Scholar
  • 9 Chauhan SP, Magann EF, Carroll CS, Barrilleaux PS, Scardo JA, Martin Jr JN. Mode of delivery for the morbidly obese with prior cesarean delivery: vaginal versus repeat cesarean section. Am J Obstet Gynecol 2001; 185 (02) 349-354
    CrossrefPubMedSearch in Google Scholar
  • 10 Gavard JA, Artal R. The association of gestational weight gain with birth weight in obese pregnant women by obesity class and diabetic status: a population-based historical cohort study. Matern Child Health J 2014; 18 (04) 1038-1047
    CrossrefPubMedSearch in Google Scholar
  • 11 Goldstein RF, Abell SK, Ranasinha S. , et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA 2017; 317 (21) 2207-2225
    CrossrefPubMedSearch in Google Scholar
  • 12 Nohr EA, Vaeth M, Baker JL, Sørensen TIa, Olsen J, Rasmussen KM. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr 2008; 87 (06) 1750-1759
    CrossrefPubMedSearch in Google Scholar
  • 13 Institute of Medicine. Nutrition during Pregnancy: Part I: Weight Gain, Part II: Nutrient Supplements. Washington, DC: IOM; 1990
    Search in Google Scholar
  • 14 Institute of Medicine. Weight Gain during Pregnancy: Reexaming the Guidelines. Washington, DC: IOM; 2009
    Search in Google Scholar
  • 15 American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol 2013; 121 (01) 210-212
    CrossrefPubMedSearch in Google Scholar
  • 16 Haugen M, Brantsæter AL, Winkvist A. , et al. Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: a prospective observational cohort study. BMC Pregnancy Childbirth 2014; 14: 201
    CrossrefPubMedSearch in Google Scholar
  • 17 Alberico S, Montico M, Barresi V. , et al; Multicentre Study Group on Mode of Delivery in Friuli Venezia Giulia. The role of gestational diabetes, pre-pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia: results from a prospective multicentre study. BMC Pregnancy Childbirth 2014; 14: 23
    CrossrefPubMedSearch in Google Scholar
  • 18 Bodnar LM, Siega-Riz AM, Simhan HN, Himes KP, Abrams B. Severe obesity, gestational weight gain, and adverse birth outcomes. Am J Clin Nutr 2010; 91 (06) 1642-1648
    CrossrefPubMedSearch in Google Scholar
  • 19 Grobman WA, Lai Y, Landon MB. , et al; National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network (MFMU). Development of a nomogram for prediction of vaginal birth after cesarean delivery. Obstet Gynecol 2007; 109 (04) 806-812
    CrossrefPubMedSearch in Google Scholar
  • 20 Viswanathan M, Siega-Riz AM, Moos MK. , et al. Outcomes of maternal weight gain. Evid Rep Technol Assess (Full Rep) 2008; 168 (168) 1-223
    PubMedSearch in Google Scholar
  • 21 Maykin MM, Mularz AJ, Lee LK, Valderramos SG. Validation of a prediction model for vaginal birth after cesarean delivery reveals unexpected success in a diverse American population. AJP Rep 2017; 7 (01) e31-e38
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Shanks AL, Cahill AG. Delivery after prior cesarean: success rate and factors. Clin Perinatol 2011; 38 (02) 233-245
    CrossrefPubMedSearch in Google Scholar
  • 23 Micek M, Kosinska-Kaczynska K, Godek B, Krowicka M, Szymusik I, Wielgos M. Birth after a previous cesarean section - what is most important in making a decision?. Neuroendocrinol Lett 2014; 35 (08) 718-723
    PubMedSearch in Google Scholar