Neonatal outcomes in obese mothers: a population-based analysis

BMC Pregnancy and Childbirth

Yvon Englert¹  Myriam De Spiegelaere⁴  Pierre Buekens²  Anne-Frederique Minsart³ 

[1] Department of Obstetrics and Gynecology and Research Laboratory for Human Reproduction, University Hospital Erasme and Faculty of Medicine, Université Libre de Bruxelles, Brussels, 1070, Belgium;School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA;Service de Gynécologie-Obstétrique, Hôpital Universitaire Erasme, Université Libre de Bruxelles, Route de Lennik, 808, Brussels, 1070, Belgium;Brussels-Capital Health and Social Observatory, Brussels, Belgium

关键词: Obstetric labor (MeSH);    Obstetric delivery (MeSH);    Perinatal mortality (MeSH);    Apgar score (MeSH);    Neonatal (MeSH);    Intensive care;    Obesity (MeSH);   

Others  :  1138233
DOI  :  10.1186/1471-2393-13-36

 received in 2012-10-06, accepted in 2013-01-31,  发布年份 2013

【 摘 要 】

Background

If it is well known that obesity increases morbidity for both mother and fetus and is associated with a variety of adverse reproductive outcomes, then few studies have assessed the relation between obesity and neonatal outcomes. This is the aim of the present study after taking into account type of labor and delivery, as well as social, medical and hospital characteristics in a population-based analysis.

Methods

This study used 2009 data from the Belgian birth register data pertaining to the regions of Brussels and Wallonia and included 38,675 consecutive births. Odds ratio and 95% confidence intervals for admission to neonatal intensive care unit, Apgar score, and perinatal mortality were calculated by logistic regression analyses adjusting for medical, social and hospital characteristics using obesity as the primary independent variable. The impact of analyzing all delivery sites together was tested using mixed-effect analyses.

Results

The adjusted odds ratio for neonatal intensive care unit admission was higher for obese mothers by 38% compared to non-obese mothers (95% confidence interval (CI): 1.22-1.56), and by 45% (CI: 1.21-1.73) and 34% (CI: 1.10-1.63) after spontaneous and induced labour respectively. The adjusted odds ratio was 1.18 (CI: 0.86-1.63) after caesarean section. The adjusted odds ratio for 1 minute Apgar score inferior to 7 was higher for obese mothers by 31% compared to non-obese mothers (CI: 1.15-1.49) and by 26% (CI: 1.04-1.52) and 38% (CI: 1.12-1.69) after spontaneous and induced labour respectively. The adjusted odds ratio was 1.50 (CI: 0.96-2.36) after caesarean section. The adjusted odds ratio for perinatal mortality was 1.36 (CI: 0.75-2.45) for obese mothers compared to non-obese mothers.

Conclusions

Neonatal admission to intensive care and low Apgar scores were more likely to occur in infants from obese mothers, both after spontaneous and induced labor.

【 授权许可】

   
2013 Minsart et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Siega-Riz AM, Laraia B: The implications of maternal overweight and obesity on the course of pregnancy and birth outcomes. Matern Child Health J 2006, 10(5 Suppl):S153-S156.
• [2]Andreasen KR, Andersen ML, Schantz AL: Obesity and pregnancy. Acta Obstet Gynecol Scand 2004, 83(11):1022-1029.
• [3]Guelinckx I, Devlieger R, Beckers K, Vansant G: Maternal obesity: pregnancy complications, gestational weight gain and nutrition. Obes Rev 2008, 9(2):140-150.
• [4]Heslehurst N, Simpson H, Ells LJ, Rankin J, Wilkinson J, Lang R, Brown TJ, Summerbell CD: The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev 2008, 9(6):635-683.
• [5]Galtier-Dereure F, Boegner C, Bringer J: Obesity and pregnancy: complications and cost. Am J Clin Nutr 2000, 71(5 Suppl):1242S-1248S.
• [6]Nohr EA, Villamor E, Vaeth M, Olsen J, Cnattingius S: Mortality in infants of obese mothers: is risk modified by mode of delivery? Acta Obstet Gynecol Scand 2012, 91(3):363-371.
• [7]Usha Kiran TS, Hemmadi S, Bethel J, Evans J: Outcome of pregnancy in a woman with an increased body mass index. BJOG 2005, 112(6):768-772.
• [8]Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ (Clinical research ed.) 2000, 320(7244):1240-1243.
• [9]Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines: Weight gain during pregnancy: reexamining the guidelines. Washington: National Academies Press; 2009.
• [10]Denison FC, Price J, Graham C, Wild S, Liston WA: Maternal obesity, length of gestation, risk of postdates pregnancy and spontaneous onset of labour at term. BJOG 2008, 115(6):720-725.
• [11]Raatikainen K, Heiskanen N, Heinonen S: Transition from overweight to obesity worsens pregnancy outcome in a BMI-dependent manner. Obesity (Silver Spring) 2006, 14(1):165-171.
• [12]Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, Regan L, Robinson S: Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord: journal of the International Association for the Study of Obesity 2001, 25(8):1175-1182.
• [13]Callaway LK, Prins JB, Chang AM, McIntyre HD: The prevalence and impact of overweight and obesity in an Australian obstetric population. Med J Aust 2006, 184(2):56-59.
• [14]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.
• [15]Rosenberg TJ, Garbers S, Chavkin W, Chiasson MA: Prepregnancy weight and adverse perinatal outcomes in an ethnically diverse population. Obstet Gynecol 2003, 102(5 Pt 1):1022-1027.
• [16]Bianco AT, Smilen SW, Davis Y, Lopez S, Lapinski R, Lockwood CJ: Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol 1998, 91(1):97-102.
• [17]Kalk P, Guthmann F, Krause K, Relle K, Godes M, Gossing G, Halle H, Wauer R, Hocher B: Impact of maternal body mass index on neonatal outcome. Eur J Med Res 2009, 14(5):216-222.
• [18]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(1):39-43.
• [19]Lumme R, Jarvelin MR, Rantakallio P, Hartikainen-Sorri AL: The starting time of prenatal care and pregnancy outcome. Duodecim 1993, 109(4):309-316.
• [20]Ovesen P, Rasmussen S, Kesmodel U: Effect of prepregnancy maternal overweight and obesity on pregnancy outcome. Obstet Gynecol 2011, 118(2 Pt 1):305-312.
• [21]Cedergren MI: Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004, 103(2):219-224.
• [22]Poobalan AS, Aucott LS, Gurung T, Smith WC, Bhattacharya S: Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women–systematic review and meta-analysis of cohort studies. Obes Rev 2009, 10(1):28-35.
• [23]Barau G, Robillard PY, Hulsey TC, Dedecker F, Laffite A, Gerardin P, Kauffmann E: Linear association between maternal pre-pregnancy body mass index and risk of caesarean section in term deliveries. BJOG 2006, 113(10):1173-1177.
• [24]Yu CK, Teoh TG, Robinson S: Obesity in pregnancy. BJOG 2006, 113(10):1117-1125.
• [25]McIntyre HD, Gibbons KS, Flenady VJ, Callaway LK: Overweight and obesity in Australian mothers: epidemic or endemic? Med J Austr 2012, 196(3):184-188.
• [26]Centre for Maternal and Child Enquiries & Royal College of Obstetricians and Gynaecologists: CMACE & RCOG Joint Guideline. Management of women with obesity in pregnancy. CMACE & RCOG, London; 2010.
• [27]Schoendorf KC, Branum AM: The use of United States vital statistics in perinatal and obstetric research. Am J Obstet Gynecol 2006, 194(4):911-915.