Download PDF
Am J Perinatol 2008; 25(9): 561-566
DOI: 10.1055/s-0028-1085623
© Thieme Medical Publishers

Pregnancy Outcome Among Obese Women: A Prospective Study

Eliezer Burstein1 , Amalia Levy2 , Moshe Mazor1 , Arnon Wiznitzer1 , Eyal Sheiner1
  • 1Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
  • 2Epidemiology and Health Services Evaluation Department, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
Further Information

Publication History

Publication Date:
03 September 2008 (online)

    Permissions and Reprints

ABSTRACT

We investigated pregnancy outcome among obese women using a prospective cohort study comparing consecutive deliveries of obese and nonobese patients. Stratified analysis, using the Mantel-Haenszel technique, was done to assess the association between obesity and the risk for cesarean delivery (CD) while controlling for confounding variables. Complete data were abstracted for 376 women, of whom 21% (n = 79) were obese. CD rate was significantly higher among obese women (32.9% versus 18.9%; p = 0.006). Maternal obesity was associated with multiparity (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.27 to 6.97; p = 0.012), fertility treatments (OR 11.3, 95% CI 2.84 to 44.89; p = 0.001), insulin-treated gestational diabetes (OR 24.55, 95% CI 2.28 to 264.08; p = 0.008), and hydramnios (OR 20.46, 95% CI 2.17 to 192.89; p = 0.008). When controlling for possible confounders, the association between maternal obesity and CD remained significant (weighted OR 2.2, 95% CI 1.2 to 4.1; p = 0.018). No significant differences were noted between the groups regarding neonatal complications. Both first and second stages of labor were longer in obese women. Obesity is a risk factor for developing gestational hypertension, insulin-treated gestational diabetes, and hydramnios. Moreover, maternal obesity is an independent risk factor for CD. Additional independent risk factors for CD were fertility treatments, insulin-treated gestational diabetes, and hydramnios. However, neonatal outcome of obese women is comparable to women with normal prepregnancy body mass index.

KEYWORDS

Obesity - cesarean delivery - pregnancy outcome

REFERENCES

  • 1 National Heart, Lung and Blood Institute .Clinical Guidelines on the Identification, Evaluation and Treatment of Obesity in Adults: The evidence report. Washington, D.C.; U.S. Department of Health and Human Services 1998
    Google Scholar
  • 2 Mokdad A H, Serdula M K, Dietz W H, Bowman B A, Marks J S, Koplan J P. The spread of the obesity epidemic in the United States, 1991–1998.  JAMA. 1999;  282 1519-1522
    CrossrefPubMedGoogle Scholar
  • 3 Ehrenberg H M, Dierker L, Milluzzi C, Mercer B M. Prevalence of maternal obesity in an urban center.  Am J Obstet Gynecol. 2002;  187 1189-1193
    CrossrefPubMedGoogle Scholar
  • 4 Gross T, Sokol R J, King K C. Obesity in pregnancy: risks and outcome.  Obstet Gynecol. 1980;  56 446-450
    PubMedGoogle Scholar
  • 5 Allison D B, Fonatine K R, Manson J E, Stevens J, Van Itallie T B. Annual deaths attributable to obesity in the United States.  JAMA. 1999;  282 1530-1538
    CrossrefPubMedGoogle Scholar
  • 6 Keinan-Boker L, Noyman N, Chinich A, Green M S, Nitzan-Kaluski D. Overweight and obesity prevalence in Israel: findings of the first national health and nutrition survey (MABAT).  Isr Med Assoc J. 2005;  7 219-223
    PubMedGoogle Scholar
  • 7 Isaacs J D, Magnon E F, Martin R W, Chauhan S P, Morrison J C. Obstetric challenges of massive obesity complicating pregnancy.  J Perinatol. 1994;  14 10-14
    PubMedGoogle Scholar
  • 8 Ratner R E, Hamner L H, Isada N B. Effects of gestational weight gain in morbidly obese women: fetal morbidity.  Am J Perinatol. 1990;  7 295-299
    PubMedGoogle Scholar
  • 9 Cnattingius S, Bergstrom R, Lipworth L, Kramer M S. Prepregnancy weight and the risk of adverse pregnancy outcomes.  N Engl J Med. 1998;  338 147-152
    CrossrefPubMedGoogle Scholar
  • 10 Kumari A S. Pregnancy outcome in women with morbid obesity.  Int J Gynaecol Obstet. 2001;  73 101-107
    CrossrefPubMedGoogle Scholar
  • 11 Castro L C, Avina R L. Maternal obesity and pregnancy outcome.  Curr Opin Obstet Gynecol. 2002;  14 601-606
    CrossrefPubMedGoogle Scholar
  • 12 Robinson H, Tkatch S, Mayes D C, Bott N, Okun N. Is maternal obesity a predictor of shoulder dystocia?.  Obstet Gynecol. 2003;  101 24-27
    PubMedGoogle Scholar
  • 13 Lu G C, Rouse D J, DuBard M, Cliver S, Kimberlin D, Hauth J C. The effect of the increasing prevalence of maternal obesity on perinatal morbidity.  Am J Obstet Gynecol. 2001;  185 845-849
    CrossrefPubMedGoogle Scholar
  • 14 Bo S, Menato G, Signorile A et al.. Obesity or diabetes: what is worse for the mother and for the baby?.  Diabetes Metab. 2003;  29 175-178
    CrossrefPubMedGoogle Scholar
  • 15 Sebire N J, Jolly M, Harris J P et al.. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London.  Int J Obes Relat Metab Disord. 2001;  25 1175-1182
    CrossrefPubMedGoogle Scholar
  • 16 Hood D D, Dewan D M. Anesthetic and obstetric outcome in morbid obese parturients.  Anesthesiology. 1993;  79 1210-1218
    CrossrefPubMedGoogle Scholar
  • 17 Myles T D, Gooch J, Santolaya J. Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery.  Obstet Gynecol. 2002;  100 959-964
    CrossrefPubMedGoogle Scholar
  • 18 Katzmarzyk P T, Perusse L, Rao D C, Bouchard C. Familial risk of overweight and obesity in the Canadian population using the WHO/NIH criteria.  Obes Res. 2000;  8 194-197
    CrossrefPubMedGoogle Scholar
  • 19 Friedman E A. Evolution of graphic analysis of labor.  Am J Obstet Gynecol. 1978;  132 824-827
    CrossrefPubMedGoogle Scholar
  • 20 Krishnamoorthy U, Schram C MH, Hill S R. Maternal obesity in pregnancy: is it time for meaningful research to inform preventive and management strategies?.  BJOG. 2006;  113 1134-1140
    CrossrefPubMedGoogle Scholar
  • 21 Linné Y. Effects of obesity on women's reproduction and complications during pregnancy.  Obes Rev. 2004;  5 137-143
    CrossrefPubMedGoogle Scholar
  • 22 Cnattingius S, Lambe M. Trends in smoking and overweight during pregnancy: prevalence, risks of pregnancy complications, and adverse pregnancy outcomes.  Semin Perinatol. 2002;  26 286-295
    CrossrefPubMedGoogle Scholar
  • 23 Barau G, Robillard P-Y, Hulsey T C et al.. Linear association between maternal pre-pregnancy body mass index and risk of caesarean section in term deliveries.  BJOG. 2006;  113 1173-1177
    CrossrefPubMedGoogle Scholar
  • 24 Sheiner E, Levy A, Menes T S, Silverberg D, Katz M, Mazor M. Maternal obesity as an independent risk factor for cesarean delivery.  Paediatr Perinat Epidemiol. 2004;  18 196-201
    CrossrefPubMedGoogle Scholar
  • 25 Szklarska A, Jankowska E A. Independent effects of social position and parity on body mass index among Polish adult women.  J Biosoc Sci. 2003;  35 575-583
    CrossrefPubMedGoogle Scholar
  • 26 Bastian L A, West N A, Corcoran C, Munger R G. Cache County Study on Memory, Health, and Aging . Number of children and the risk of obesity in older women.  Prev Med. 2005;  40 99-104
    CrossrefPubMedGoogle Scholar
  • 27 Fanciullacci M, De Cesaris F. Preventing chronicity of migraine.  J Headache Pain. 2005;  6 331-333
    CrossrefPubMedGoogle Scholar
  • 28 Horev A, Wirguin I, Lantsberg L, Ifergane G. A high incidence of migraine with aura among morbidly obese women.  Headache. 2005;  45 936-938
    CrossrefPubMedGoogle Scholar
  • 29 Hamon C, Fanello S, Catala L, Parot E. Maternal obesity: effects on labor and delivery. Excluding other diseases that might modify obstetrical management.  J Gynecol Obstet Biol Reprod (Paris). 2005;  34 109-114
    PubMedGoogle Scholar
  • 30 Buhimschi C S, Buhimschi I A, Malinow A M, Weiner C P. Intrauterine pressure during the second stage of labor in obese women.  Obstet Gynecol. 2004;  103 225-230
    PubMedGoogle Scholar

Eyal SheinerM.D. Ph.D. 

Department of Obstetrics and Gynecology, Soroka University Medical Center

P.O. Box 151 Beer-Sheva 84101 Israel

Email: sheiner@bgu.ac.il

      >