Obesity and gestational weight gain: cesarean delivery and labor complications

Revista de Saúde Pública

Luiz Carlos Seligman¹  Bruce Bartholow Duncan¹  Leandro Branchtein¹  Dea Suzana Miranda Gaio¹  Sotero Serrate Mengue¹  Maria Inês Schmidt¹ 

[1] ,Universidade Federal do Rio Grande do Sul Faculdade de Medicina Programa de Pós-Graduação em EpidemiologiaPorto Alegre RS ,Brasil

关键词: Cohort studies;    Obesity;    Weight gain;    Pregnancy;    Labor;    premature;    Labor complications;    Cesarean section;    Postpartum hemorrhage;    Meconium;    Perinatal mortality;    Estudos de coortes;    Obesidade;    Ganho de peso;    Gravidez;    Trabalho de parto prematuro;    Complicações do trabalho de parto;    Cesárea;    Hemorragia pós-parto;    Mecônio;    Mortalidade perinatal;   

DOI  :  10.1590/S0034-89102006000300014

来源: SciELO

【 摘 要 】

OBJECTIVE: To assess the association between pre-gestational obesity and weight gain with cesarean delivery and labor complications. METHODS: A total of 4,486 women 20-28 weeks pregnant attending general prenatal care clinics of the national health system in Brazil from 1991 to 1995 were enrolled and followed up through birth. Body mass index categories based on prepregnancy weight and total weight gain were calculated. Associations between body mass index categories and labor complications were adjusted through logistic regression analysis. RESULTS: Obesity was present in 308 (6.9%) patients. Cesarean delivery was performed in 164 (53.2%) obese, 407 (43.1%) pre-obese, 1,045 (35.1%) normal weight and 64 (24.5%) underweight women. The relative risk for cesarean delivery in obese women was 1.8 (95% CI: 1.5-2.0) compared to normal weight women. Greater weight gain was particularly associated with cesarean among the obese (RR 4th vs 2nd weight gain quartile 2.2; 95% CI: 1.4-3.2). Increased weight at the beginning of pregnancy was associated with a significantly higher adjusted risk of meconium with vaginal delivery and perinatal death and infection in women submitted to cesarean section. Similarly, greater weight gain during pregnancy increased the risk for meconium and hemorrhage in women submitted to vaginal delivery and for prematurity with cesarean. CONCLUSIONS: Pre-gestational obesity and greater weight gain independently increase the risk of cesarean delivery, as well as of several adverse outcomes with vaginal delivery. These findings provide further evidence of the negative effects of prepregnancy obesity and greater gestational weight gain on pregnancy outcomes.

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