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CC BY-NC-ND 4.0 · AJP Rep 2021; 11(02): e105-e112
DOI: 10.1055/s-0041-1732409
Original Article

Association between Maternal Obesity Class, Adherence to Labor Guidelines, and Perinatal Outcomes

Irene A. Stafford
1   Department of Obstetrics and Gynecology, University of Texas Health Science Center, Houston, Texas
,
Ahmed S.Z. Moustafa
2   Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University, Flint, Michigan
,
Lauren Spoo
3   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
,
Alexandra Berra
3   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
,
Angela Burgess
1   Department of Obstetrics and Gynecology, University of Texas Health Science Center, Houston, Texas
,
Mark Turrentine
3   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Abstract

Background Data are limited concerning rates of perinatal complications in women with a body mass index (BMI) ≥40 kg/m2 compared to women with other BMI classes when guidelines for the safe prevention of the primary cesarean delivery are applied.

Objective The aim of the study is to evaluate labor guideline adherence by BMI class and to compare perinatal outcomes across BMI classes with guideline adherent management.

Study Design This retrospective study included low-risk women admitted for delivery between April 2014 and April 2017 after the labor guidelines were implemented. BMI closest to delivery was used for analysis. Women with cesarean for nonreassuring fetal status were excluded.

Results Guideline adherence decreased with increasing BMI, with 93% adherence among women of normal weight compared to 81% for class III obese women (p < 0.0001). Among women who had guideline-adherent management, there was increased rates of cesarean among class III versus other obesity classes; however, there were no differences in rates of infectious morbidity (p = 0.98) or hemorrhage (p = 0.93). Although newborns of women with class III obesity had higher rates of meconium at birth, neonatal outcomes were not different with increasing maternal BMI (p = 0.65).

Conclusion There were no differences in adverse perinatal outcomes with increasing BMI.

Keywords

overweight - obesity - labor dystocia - primary cesarean guidelines

Note

IRB approval: H-26364.


This work has not been published previously and is not under consideration for publication elsewhere.




Publication History

Received: 12 January 2020

Accepted: 06 April 2020

Article published online:
15 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012; 307 (05) 491-497
    CrossrefPubMedGoogle Scholar
  • 2 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014; 311 (08) 806-814
    CrossrefPubMedGoogle Scholar
  • 3 Catalano PM. Management of obesity in pregnancy. Obstet Gynecol 2007; 109 (2 Pt 1): 419-433
    CrossrefPubMedGoogle Scholar
  • 4 Weiss JL, Malone FD, Emig D. et al; FASTER Research Consortium. Obesity, obstetric complications and cesarean delivery rate—a population-based screening study. Am J Obstet Gynecol 2004; 190 (04) 1091-1097
    CrossrefPubMedGoogle Scholar
  • 5 Anderson NH, McCowan LM, Fyfe EM. et al; SCOPE Consortium. The impact of maternal body mass index on the phenotype of pre-eclampsia: a prospective cohort study. BJOG 2012; 119 (05) 589-595
    CrossrefPubMedGoogle Scholar
  • 6 Salihu HM, Dunlop AL, Hedayatzadeh M, Alio AP, Kirby RS, Alexander GR. Extreme obesity and risk of stillbirth among black and white gravidas. Obstet Gynecol 2007; 110 (03) 552-557
    CrossrefPubMedGoogle Scholar
  • 7 Yao R, Ananth CV, Park BY, Pereira L, Plante LA. Obesity and the risk of stillbirth: a population-based cohort study. Perinatal research consortium. Am J Obstet Gynecol 2014; 210: 457.e1-457.e9
    CrossrefPubMedGoogle Scholar
  • 8 Salihu HM, Luke S, Alio AP, Deutsch A, Marty PJ. The impact of obesity on spontaneous and medically indicated preterm birth among adolescent mothers. Arch Gynecol Obstet 2010; 282 (02) 127-134
    CrossrefPubMedGoogle Scholar
  • 9 Hibbard JU, Gilbert S, Landon MB. et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery. Obstet Gynecol 2006; 108 (01) 125-133
    CrossrefPubMedGoogle Scholar
  • 10 Chu SY, Callaghan WM, Kim SY. et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 2007; 30 (08) 2070-2076
    CrossrefPubMedGoogle Scholar
  • 11 Nuthalapaty FS, Rouse DJ, Owen J. The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction. Obstet Gynecol 2004; 103 (03) 452-456
    PubMedGoogle Scholar
  • 12 Chu SY, Kim SY, Schmid CH. et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev 2007; 8 (05) 385-394
    CrossrefPubMedGoogle Scholar
  • 13 Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E. Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. BJOG 2012; 119 (11) 1324-1333
    CrossrefPubMedGoogle Scholar
  • 14 Duhl AJ, Paidas MJ, Ural SH. et al; Pregnancy and Thrombosis Working Group. Antithrombotic therapy and pregnancy: consensus report and recommendations for prevention and treatment of venous thromboembolism and adverse pregnancy outcomes. Am J Obstet Gynecol 2007; 197 (05) 457.e1-457.e21
    CrossrefPubMedGoogle Scholar
  • 15 Gross T, Sokol RJ, King KC. Obesity in pregnancy: risks and outcome. Obstet Gynecol 1980; 56 (04) 446-450
    PubMedGoogle Scholar
  • 16 Antony KM, Hemarajata P, Chen J. et al. Generation and validation of a universal perinatal database and biospecimen repository: PeriBank. J Perinatol 2016; 36 (11) 921-929
    CrossrefPubMedGoogle Scholar
  • 17 Committeee on Practice Bulletins. Obstetrics Practice Bulletin No. 156. Obesity in pregnancy. The American College of Obstetrics and Gynecology. Practice bulletin no 156. Obstet Gynecol 2015; 126: e112-e126
    CrossrefPubMedGoogle Scholar
  • 18 Arrowsmith S, Wray S, Quenby S. Maternal obesity and labour complications following induction of labour in prolonged pregnancy. BJOG 2011; 118 (05) 578-588
    CrossrefPubMedGoogle Scholar
  • 19 Nuthalapaty FS, Rouse DJ, Owen J. The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction. Obstet Gynecol 2004; 103 (03) 452-456
    PubMedGoogle Scholar
  • 20 Robinson BK, Mapp DC, Bloom SL. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the Maternal-Fetal Medicine Units Network (MFMU). Increasing maternal body mass index and characteristics of the second stage of labor. Obstet Gynecol 2011; 118 (06) 1309-1313
    CrossrefPubMedGoogle Scholar
  • 21 ACOG Committee on Practice Bulletins—Obstetrics.. Induction of labor. ACOG Practice Bulletin No. 107. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009; 114: 386-397
    CrossrefPubMedGoogle Scholar
  • 22 Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA 2010; 303 (03) 235-241
    CrossrefPubMedGoogle Scholar
  • 23 Aune D, Saugstad OD, Henriksen T, Tonstad S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA 2014; 311 (15) 1536-1546
    CrossrefPubMedGoogle Scholar
  • 24 Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2012; 120 (05) 1181-1193
    CrossrefPubMedGoogle Scholar
  • 25 Lynch AM, Hart JE, Agwu OC, Fisher BM, West NA, Gibbs RS. Association of extremes of prepregnancy BMI with the clinical presentations of preterm birth. Am J Obstet Gynecol 2014; 210 (05) 428.e1-428.e9
    CrossrefPubMedGoogle Scholar
  • 26 Hendler I, Goldenberg RL, Mercer BM. et al. The preterm prediction study: association between maternal body mass index and spontaneous and indicated preterm birth. Am J Obstet Gynecol 2005; 192 (03) 882-886
    CrossrefPubMedGoogle Scholar
  • 27 Vahratian A, Zhang J, Troendle JF, Savitz DA, Siega-Riz AM. Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women. Obstet Gynecol 2004; 104 (5 Pt 1): 943-951
    CrossrefPubMedGoogle Scholar
  • 28 Young TK, Woodmansee B. Factors that are associated with cesarean delivery in a large private practice: the importance of prepregnancy body mass index and weight gain. Am J Obstet Gynecol 2002; 187 (02) 312-318 , discussion 318–320
    CrossrefPubMedGoogle Scholar
  • 29 Kawakita T, Reddy UM, Landy HJ, Iqbal SN, Huang CC, Grantz KL. Indications for primary cesarean delivery relative to body mass index. Am J Obstet Gynecol 2016; 215 (04) 515.e1-515.e9
    CrossrefPubMedGoogle Scholar
  • 30 American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol 2014; 123 (03) 693-711
    CrossrefPubMedGoogle Scholar
  • 31 Antony KM, Hemarajata P, Chen J. et al. Generation and validation of a universal perinatal database and biospecimen repository: PeriBank. J Perinatol 2016; 36 (11) 921-929
    CrossrefPubMedGoogle Scholar
  • 32 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370 (9596): 1453-1457
    CrossrefPubMedGoogle Scholar
  • 33 Geller G, Watkins PA. Addressing medical students' negative bias toward patients with obesity through ethics education. AMA J Ethics 2018; 20 (10) E948-E959
    CrossrefPubMedGoogle Scholar
  • 34 Pillutla V, Maslen H, Savulescu J. Rationing elective surgery for smokers and obese patients: responsibility or prognosis?. BMC Med Ethics 2018; 19 (01) 28
    CrossrefPubMedGoogle Scholar
  • 35 Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev 2015; 16 (04) 319-326
    CrossrefPubMedGoogle Scholar
  • 36 Use of prophylactic antibiotics in labor and delivery. ACOG Practice Bulletin No. 199. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018; 132: e103-e119
    CrossrefPubMedGoogle Scholar
  • 37 Blomberg M. Maternal obesity and risk of postpartum hemorrhage. Obstet Gynecol 2011; 118 (03) 561-568
    CrossrefPubMedGoogle Scholar
  • 38 Sinkey RG, Blanchard CT, Szychowski JM. et al. Elective induction of labor in the 39th week of gestation compared with expectant management of low-risk multiparous women. Obstet Gynecol 2019; 134 (02) 282-287
    CrossrefPubMedGoogle Scholar
  • 39 Chen HY, Grobman WA, Blackwell SC, Chauhan SP. Neonatal and maternal adverse outcomes among low-risk parous women at 39-41 weeks of gestation. Obstet Gynecol 2019; 134 (02) 288-294
    CrossrefPubMedGoogle Scholar
  • 40 Sewell MF, Huston-Presley L, Super DM, Catalano P. Increased neonatal fat mass, not lean body mass, is associated with maternal obesity. Am J Obstet Gynecol 2006; 195 (04) 1100-1103
    CrossrefPubMedGoogle Scholar
  • 41 Hull HR, Dinger MK, Knehans AW, Thompson DM, Fields DA. Impact of maternal body mass index on neonate birthweight and body composition. Am J Obstet Gynecol 2008; 198 (04) 416.e1-416.e6
    CrossrefPubMedGoogle Scholar