Risk of First-Stage and Second-Stage Cesarean Delivery by Maternal Body Mass Index Among Nulliparous Women in Labor at Term
- 1 June 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Obstetrics & Gynecology
- Vol. 117 (6), 1315-1322
- https://doi.org/10.1097/aog.0b013e318217922a
Abstract
To estimate in a cohort of nulliparous women in labor at term whether cesarean delivery rates are increased in first and second stages of labor in overweight and obese women and whether being overweight or obese is an independent risk factor for cesarean delivery. Nulliparous women recruited to the prospective Screening for Pregnancy Endpoints study who went into labor after 37 weeks of gestation were categorized according to ethnicity-specific body mass index (BMI) criteria as normal, overweight, or obese. Normal BMI was the referent. Multivariable analysis, adjusting for known confounders for obesity and cesarean delivery, was performed to estimate if being overweight or obese was associated with an increased risk of cesarean in labor (all cesarean deliveries and in first stage of labor). Of 2,629 participants, 1,416 (54%) had normal BMIs, 773 (29%) were overweight, and 440 (17%) were obese. First-stage cesarean delivery was increased in overweight (n=149 [19%]) and obese (n=137 [31%]) women compared with normal-weight women (n=181 [13%; P<.001), whereas second-stage cesarean delivery was similar (normal BMI 76 [6.2%], overweight 45 [7.2%], obese 23 [7.6%], P=.87). Being overweight or obese was an independent risk factor for all cesarean deliveries in labor with adjusted odds ratio (OR) of 1.34 (95% confidence interval [CI] 1.07–1.67) and 2.51 (95% CI 1.94–3.25), respectively. Similarly, being overweight (adjusted OR 1.39; 95% CI 1.09–1.79) or obese (adjusted OR 2.89; 95% CI 2.19–3.80) was associated with increased cesarean delivery during the first stage. Risks of cesarean delivery were similar regardless of whether ethnicity-specific or World Health Organization (WHO) BMI criteria were used. Among nulliparous women in labor at term, being overweight or obese by either WHO or ethnicity-specific BMI criteria is an independent risk factor for cesarean delivery in the first stage but not the second stage of labor. Australian New Zealand Clinical Trials Registry, www.anzctr.org.au, ACTRN12607000551493. IIKeywords
This publication has 24 references indexed in Scilit:
- Maternal and perinatal outcome in obese pregnant patientsThe Journal of Maternal-Fetal & Neonatal Medicine, 2009
- The impact of maternal BMI status on pregnancy outcomes with immediate short‐term obstetric resource implications: a meta‐analysisObesity Reviews, 2008
- Trends in maternal obesity and associated risks of adverse pregnancy outcomes in a population of Chinese womenBJOG: An International Journal of Obstetrics and Gynaecology, 2008
- Pregnancy Outcome Among Obese Women: A Prospective StudyAmerican Journal of Perinatology, 2008
- Maternal body mass index in the first trimester and risk of cesarean delivery in nulliparous women in spontaneous laborAmerican Journal of Obstetrics and Gynecology, 2007
- The incidence and impact of increased body mass index on maternal and fetal morbidity in the low-risk primigravid populationThe Journal of Maternal-Fetal & Neonatal Medicine, 2007
- Pre‐pregnancy body mass index and pregnancy outcomesInternational Journal of Gynecology & Obstetrics, 2006
- Maternal Pre-pregnancy Overweight and Obesity and the Risk of Cesarean Delivery in Nulliparous WomenAnnals of Epidemiology, 2005
- Appropriate body-mass index for Asian populations and its implications for policy and intervention strategiesThe Lancet, 2004
- Body size and composition in PolynesiansInternational Journal of Obesity, 1999