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)

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.

REFERENCES

  • 1 American College of Obstetricians and Gynecologists . ACOG Committee Opinion No. 315. Obesity in pregnancy.  Obstet Gynecol. 2005;  106 671-675
  • 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
  • 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
  • 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
  • 6 Cedergren M I. Maternal morbid obesity and the risk of adverse pregnancy outcome.  Obstet Gynecol. 2004;  103 219-224
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 15 Kiran U, Evans J. Poor uterine contractility in obese women.  BJOG. 2007;  114 1304-1305
  • 16 Zhang J, Bricker L, Wray S, Quenby S. Poor uterine contractility in obese women.  BJOG. 2007;  114 343-348
  • 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

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