Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2017; 39(07): 330-336
DOI: 10.1055/s-0037-1603826
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Effect of Obesity on Gestational and Perinatal Outcomes

Efeito da obesidade sobre os resultados gestacionais e perinatais
Sônia Regina Cabral Madi
1   Gynecology and Obstetrics Department, Hospital Geral, Fundação Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, RS, Brazil
,
Rosa Maria Rahmi Garcia
2   Endocrinology and Nutrition Department, Fundação Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, RS, Brazil
,
Vandrea Carla de Souza
3   Neonatology Department, Fundação Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, RS, Brazil
,
Renato Luís Rombaldi
1   Gynecology and Obstetrics Department, Hospital Geral, Fundação Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, RS, Brazil
,
Breno Fauth de Araújo
1   Gynecology and Obstetrics Department, Hospital Geral, Fundação Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, RS, Brazil
,
José Mauro Madi
1   Gynecology and Obstetrics Department, Hospital Geral, Fundação Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, RS, Brazil
› Author Affiliations
Further Information

Publication History

29 May 2016

06 March 2017

Publication Date:
23 June 2017 (online)

   Permissions and Reprints

Abstract

Purpose To assess the impact of pre-pregnancy obesity (body mass index [BMI] ≥ 30 kg/m2) on the gestational and perinatal outcomes.

Methods Retrospective cohort study of 731 pregnant women with a BMI ≥ 30 kg/m2 at the first prenatal care visit, comparing them with 3,161 women with a BMI between 18.5 kg/m2 and 24.9 kg/m2. Maternal and neonatal variables were assessed. Statistical analyses reporting the demographic features of the pregnant women (obese and normal) were performed with descriptive statistics followed by two-sided independent Student's t tests for the continuous variables, and the chi-squared (χ2) test, or Fisher's exact test, for the categorical variables. We performed a multiple linear regression analysis of newborn body weight based on the mother's BMI, adjusted by maternal age, hyperglycemic disorders, hypertensive disorders, and cesarean deliveries to analyze the relationships among these variables. All analyses were performed with the R (R Foundation for Statistical Computing, Vienna, Austria) for Windows software, version 3.1.0. A value of p < 0.05 was considered statistically significant.

Results Obesity was associated with older age [OR 9.8 (7.8–12.2); p < 0.01], hyperglycemic disorders [OR 6.5 (4.8–8.9); p < 0.01], hypertensive disorders [OR 7.6 (6.1–9.5); p < 0.01], caesarean deliveries [OR 2.5 (2.1–3.0); p < 0.01], fetal macrosomia [OR 2.9 (2.3–3.6); p < 0.01] and umbilical cord pH [OR 2.1 (1.4–2.9); p < 0.01). Conversely, no association was observed with the duration of labor, bleeding during labor, Apgar scores at 1 and 5 minutes after birth, gestational age, stillbirth and early neonatal mortality, congenital malformations, and maternal and fetal injury.

Conclusion We observed that pre-pregnancy obesity was associated with maternal age, hyperglycemic disorders, hypertension syndrome, cesarean deliveries, fetal macrosomia, and fetal acidosis.

Resumo

Objetivo Avaliar o impacto da obesidade pré-gestacional (índice de massa corpórea [IMC] ≥ 30 kg/m2) sobre os resultados gestacionais e perinatais.

Métodos Estudo transversal retrospectivo, com 731 gestantes que apresentaram IMC ≥ 30 kg/m2 na primeira consulta de pré-natal, comparando-as a 3.161 gestantes com IMC entre 18,5 kg/m2 e 24,9 kg/m2. Foram avaliadas variáveis maternas e neonatais. A análise estatística baseou-se nas características demográficas das gestantes (obesas e com peso normal), e foi realizada com estatísticas descritivas seguidas de testes t de Student independentes bicaudais para variáveis contínuas, e teste de qui-quadrado (χ2) ou exato de Fisher para as variáveis categóricas. Foi realizada uma regressão linear múltipla do peso do recém-nascido sobre o IMC materno, ajustado por idade materna, síndromes hiperglicêmicas, síndromes hipertensivas hipertensivas e operações cesarianas, a fim de analisar a relação entre essas variáveis. Todas as análises foram realizadas com o uso de R (R Foundation for Statistical Computing, Viena, Áustria) para Windows, versão 3.1.0. Um valor de p < 0,05 foi considerado estatisticamente significante.

Resultados A obesidade associou-se à idade materna [OR 9,8 (7,8–12,2); p < 0,01], distúrbios hiperglicêmicos [OR 6.5 (4,8–8,9); p < 0,01], distúrbios hipertensivos (RP: 7,6 [6,1–9,5]; p < 0,01), maior taxa de operação cesariana [OR 2,5 (2,1–3,0); p < 0,01], macrossomia fetal [OR 2,9 (2,3–3,6); p < 0,01] e baixo pH na artéria umbilical [OR 2,1 (1,4–2,9); p < 0,01]. Não foi observada associação com tempo de trabalho de parto, sangramento durante o trabalho de parto, índice de Apgar no 1° e 5° minutos, idade gestacional, natimortalidade e mortalidade neonatal precoce, malformações congênitas e tocotraumatismo materno e fetal.

Conclusões O estudo mostrou que a obesidade pré-gestacional associou-se com idade materna mais elevada, distúrbios hiperglicêmicos e hipertensivos, taxas mais altas de operação cesariana, macrossomia e acidose fetal.

Keywords

obesity - body mass index - pregnancy outcomes - neonatal outcomes

Palavras-chave

obesidade - índice de massa corpórea - desfechos gestacionais - desfechos neonatais
 

  • References

  • 1 World Health Organization [Internet]. Global Health Observatory (GHO). Obesity: situation and trends. 2016 [cited 2016 Sep 10]. Available from: http://www.who.int/gho/ncd/risk_factors/obesity_text/en
    PubMedGoogle Scholar
  • 2 World Health Organization [Internet]. Global Health Observatory (GHO) data. Overweight and obesity. 2016 [cited 2016 Sep 10]. Available from: http://www.who.int/gho/ncd/risk_factors/overweight/en
    PubMedGoogle Scholar
  • 3 Nucci LB, Schmidt MI, Duncan BB, Fuchs SC, Fleck ET, Santos Britto MM. Nutritional status of pregnant women: prevalence and associated pregnancy outcomes. Rev Saude Publica 2001; 35 (06) 502-507
    CrossrefPubMedGoogle Scholar
  • 4 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde [Internet]. Vigitel Brasil 2013: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília (DF): Ministério da Saúde; 2014 [cited 2016 Set 10]. Available from: https://biavati.files.wordpress.com/2014/05/vigitel-2013.pdf
    PubMedGoogle Scholar
  • 5 Tennant PW, Rankin J, Bell R. Maternal body mass index and the risk of fetal and infant death: a cohort study from the North of England. Hum Reprod 2011; 26 (06) 1501-1511
    CrossrefPubMedGoogle Scholar
  • 6 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
  • 7 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
    CrossrefPubMedGoogle Scholar
  • 8 Sebire NJ, Jolly M, Harris JP. , et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001; 25 (08) 1175-1182
    CrossrefPubMedGoogle Scholar
  • 9 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
  • 10 Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004; 103 (02) 219-224
    CrossrefPubMedGoogle Scholar
  • 11 Anderson JL, Waller DK, Canfield MA, Shaw GM, Watkins ML, Werler MM. Maternal obesity, gestational diabetes, and central nervous system birth defects. Epidemiology 2005; 16 (01) 87-92
    CrossrefPubMedGoogle Scholar
  • 12 Ray JG, Wyatt PR, Vermeulen MJ, Meier C, Cole DE. Greater maternal weight and the ongoing risk of neural tube defects after folic acid flour fortification. Obstet Gynecol 2005; 105 (02) 261-265
    CrossrefPubMedGoogle Scholar
  • 13 Stepan H, Scheithauer S, Dornhöfer N, Krämer T, Faber R. Obesity as an obstetric risk factor: does it matter in a perinatal center?. Obesity (Silver Spring) 2006; 14 (05) 770-773
    CrossrefPubMedGoogle Scholar
  • 14 Rasmussen SA, Chu SY, Kim SY, Schmid CH, Lau J. Maternal obesity and risk of neural tube defects: a metaanalysis. Am J Obstet Gynecol 2008; 198 (06) 611-619
    CrossrefPubMedGoogle Scholar
  • 15 Johansson S, Villamor E, Altman M, Bonamy AKE, Granath F, Cnattingius S. Maternal overweight and obesity in early pregnancy and risk of infant mortality: a population based cohort study in Sweden. BMJ 2014; 349: g6572
    CrossrefPubMedGoogle Scholar
  • 16 Institute of Medicine. National Research Council. Committee to Reexamine IOM Pregnancy Weight Guidelines. Food and Nutrition Board and Board on Children, Youth and Families. Weight gain during pregnancy: reexamining the guidelines. Washington (DC): National Academies Press; 2009
    Google Scholar
  • 17 Sociedade Brasileira de Diabetes [Internet]. Diretrizes Sociedade Brasileira de Diabetes 2015–2016. 2016 [cited 2016 Set 26]. Available from: http://bibliofarma.com/diretrizes-sbd-2015-2016/
    PubMedGoogle Scholar
  • 18 Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000; 183 (01) S1-S22
    CrossrefPubMedGoogle Scholar
  • 19 Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr 1967; 71 (02) 159-163
    CrossrefPubMedGoogle Scholar
  • 20 ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 348, November 2006: Umbilical cord blood gas and acid-base analysis. Obstet Gynecol 2006; 108 (05) 1319-1322
    CrossrefPubMedGoogle Scholar
  • 21 Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med 2001; 344 (07) 467-471
    CrossrefPubMedGoogle Scholar
  • 22 Pleis JR, Lethbridge-Cejku M. Summary health statistics for U.S. adults: National Health Interview Survey, 2006. Vital Health Stat 10 2007; (235) 1-153
    PubMedGoogle Scholar
  • 23 Gross T, Sokol RJ, King KC. Obesity in pregnancy: risks and outcome. Obstet Gynecol 1980; 56 (04) 446-450
    PubMedGoogle Scholar
  • 24 Bodnar LM, Catov JM, Klebanoff MA, Ness RB, Roberts JM. Prepregnancy body mass index and the occurrence of severe hypertensive disorders of pregnancy. Epidemiology 2007; 18 (02) 234-239
    CrossrefPubMedGoogle Scholar
  • 25 Torloni MR, Betrán AP, Horta BL. , et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev 2009; 10 (02) 194-203
    CrossrefPubMedGoogle Scholar
  • 26 Baron CM, Girling LG, Mathieson AL. , et al. Obstetrical and neonatal outcomes in obese parturients. J Matern Fetal Neonatal Med 2010; 23 (08) 906-913
    CrossrefPubMedGoogle Scholar
  • 27 Chandrasekaran S, Levine LD, Durnwald CP, Elovitz MA, Srinivas SK. Excessive weight gain and hypertensive disorders of pregnancy in the obese patient. J Matern Fetal Neonatal Med 2015; 28 (08) 964-968
    CrossrefPubMedGoogle Scholar
  • 28 Rode L, Nilas L, Wøjdemann K, Tabor A. Obesity-related complications in Danish single cephalic term pregnancies. Obstet Gynecol 2005; 105 (03) 537-542
    CrossrefPubMedGoogle Scholar
  • 29 Gunatilake RP, Smrtka MP, Harris B. , et al. Predictors of failed trial of labor among women with an extremely obese body mass index. Am J Obstet Gynecol 2013; 209 (06) 562.e1-562.e5
    CrossrefPubMedGoogle Scholar
  • 30 Conner SN, Tuuli MG, Longman RE, Odibo AO, Macones GA, Cahill AG. Impact of obesity on incision-to-delivery interval and neonatal outcomes at cesarean delivery. Am J Obstet Gynecol 2013; 209 (04) 386.e1-386.e6
    CrossrefPubMedGoogle Scholar
  • 31 Abenhaim HA, Kinch RA, Morin L, Benjamin A, Usher R. Effect of prepregnancy body mass index categories on obstetrical and neonatal outcomes. Arch Gynecol Obstet 2007; 275 (01) 39-43
    CrossrefPubMedGoogle Scholar
  • 32 Bautista-Castaño I, Henriquez-Sanchez P, Alemán-Perez N. , et al. Maternal obesity in early pregnancy and risk of adverse outcomes. PLoS One 2013; 8 (11) e80410
    CrossrefPubMedGoogle Scholar
  • 33 Perlow JH, Morgan MA, Montgomery D, Towers CV, Porto M. Perinatal outcome in pregnancy complicated by massive obesity. Am J Obstet Gynecol 1992; 167 (4 Pt 1): 958-962
    CrossrefPubMedGoogle Scholar
  • 34 Kumari AS. Pregnancy outcome in women with morbid obesity. Int J Gynaecol Obstet 2001; 73 (02) 101-107
    CrossrefPubMedGoogle Scholar
  • 35 Baeten JM, Bukusi EA, Lambe M. Pregnancy complications and outcomes among overweight and obese nulliparous women. Am J Public Health 2001; 91 (03) 436-440
    CrossrefPubMedGoogle Scholar
  • 36 Shaw GM, Velie EM, Schaffer D. Risk of neural tube defect-affected pregnancies among obese women. JAMA 1996; 275 (14) 1093-1096
    CrossrefPubMedGoogle Scholar
  • 37 Watkins And ML, Botto LD. Maternal prepregnancy weight and congenital heart defects in the offspring. Epidemiology 2001; 11 (04) 439-446
    CrossrefPubMedGoogle Scholar
  • 38 Watkins ML, Rasmussen SA, Honein MA, Botto LD, Moore CA. Maternal obesity and risk for birth defects. Pediatrics 2003; 111 (5 Pt 2): 1152-1158
    CrossrefPubMedGoogle Scholar
  • 39 Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 2009; 301 (06) 636-650
    CrossrefPubMedGoogle Scholar
  • 40 Paulino DS, Surita FG, Peres GB, do Nascimento SL, Morais SS. Association between parity, pre-pregnancy body mass index and gestational weight gain. J Matern Fetal Neonatal Med 2016; 29 (06) 880-884
    CrossrefPubMedGoogle Scholar
  • 41 Godoy AC, Nascimento SL, Surita FG. A systematic review and meta-analysis of gestational weight gain recommendations and related outcomes in Brazil. Clinics (Sao Paulo) 2015; 70 (11) 758-764
    CrossrefPubMedGoogle Scholar
  • 42 Guelinckx I, Devlieger R, Beckers K, Vansant G. Maternal obesity: pregnancy complications, gestational weight gain and nutrition. Obes Rev 2008; 9 (02) 140-150
    CrossrefPubMedGoogle Scholar