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Obesity increased risk for adverse maternal, neonatal outcomes
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Women who are obese are more likely to require specialty care during their pregnancy as a result of significantly adverse maternal and neonatal outcomes, researchers suggest.
In a retrospective study, researchers collected data from the Northern Ireland Maternity System on 30,298 births between 2004 and 2011. Women were categorized into six groups: underweight (2.8%); normal weight (52.5%); overweight (27.8%); obese class I (11%); obese class II (3.9%) and obese class III (1.9%).
“By having obesity in sub-classifications, we were able to highlight the relationship between increasing BMI and the increasing risk of adverse outcomes, with women most at risk in obese class 3 requiring specialist medical care during pregnancy,” researcher Valerie A. Holmes, RGN, BSc, PGCHET, PhD, of the School of Nursing and Midwifery at Queen’s University in Belfast, Ireland, said in a press release.
According to data, compared with women of normal weight, those who were overweight or obese class I had a significantly increased risk for hypertensive disorders of pregnancy (OR=1.9; 99% CI, 1.7-2.3 vs. OR=3.5; 99% CI, 2.9-4.2); gestational diabetes (OR=1.7; 99% CI, 1.3-2.3 vs. OR=3.7; 99% CI, 2.8-5); induction of labor (OR=1.2; 99% CI, 1.1-1.3 vs. OR=1.3; 99% CI, 1.2-1.5); cesarean section (OR=1.4; 99% CI, 1.3-1.5 vs. OR=1.8; 99% CI, 1.6-2); postpartum hemorrhage (OR=1.4; 99% CI, 1.3-1.5 vs. OR=1.8; 1.6-2); and macrosomia (OR=1.5; 99% CI, 1.3-1.6 vs. OR=1.9; 99% CI, 1.6-2.2). These risks increased among patients in obese classes II and III, the researchers added.
Further data indicate that women in obese class III demonstrated an increased risk for preterm delivery (OR=1.6; 99% CI, 1.1-2.5); stillbirth (OR=3; 99% CI, 1-9.3); postnatal stay of more than 5 days (OR=2.1; 99% CI, 1.5-3.1); and an infant requiring admission to a neonatal unit (OR=1.6; 99% CI, 1-2.6).
“We found that the majority of overweight women fall into the overweight or obese class I categories, and while they are still at an increased risk of gestational diabetes and hypertensive disorders in pregnancy, they may not be offered the same level of specialist care under current guidelines,” researcher Dale Spence, PhD, also from the School of Nursing and Midwifery at Queen’s University in Belfast, said in the press release.
The researchers suggest that obese and overweight women be monitored closely during pregnancy and delivery to mitigate potential adverse outcomes.
“This large-scale study clearly demonstrates that being overweight or obese during pregnancy increases the risk of adverse maternal and neonatal outcomes,” Holmes said.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Janet H. Silverstein, MD
It has long been recognized that pregnancy in obese women is associated with increased risks both to the mother and to the baby. The insulin resistance associated with obesity affects the fetus, such that the offspring has a greater risk for later development of obesity and type 2 diabetes. The paper by Scott-Pillai is of importance in that the authors were able to categorize large groups of pregnant women according to early pregnancy BMI (<16 weeks), which are thought to represent pre-pregnancy BMIs, and to categorize them by BMI according to the WHO classification.
Although it is not surprising that effects on the mother and baby were greatest for those in obese class 3, the fact that even those mothers who were overweight with BMIs in the 25 to 29.99 kg/m² range, had comorbiditites is of concern. Compared with those with normal BMIs, mothers who were overweight had an increased risk for gestational diabetes (OR=1.7), hypertension (OR=1.9), and increased risks for caesearean section and postpartum hemorrhage, whereas the newborn had an increased risk for macrosomia (OR=1.5). Infants with macrosomia have an increased risk for birth injuries, perinatal asphyxia, neonatal respiratory distress and are more likely to develop hypoglycemia. Those who were categorized as being in obese class 1 to 3 had increasing risks for having their babies admitted to neonatal intensive care units.
This confirms the findings in the Danish literature that found adjusted odds ratios were significantly increased for overweight, obese, and extremely obese. Planned and especially emergency cesarean delivery was significantly increased with increasing BMI (OR ranging from 1.2 to 2.1). The risk of giving birth to a macrosomic neonate (greater than 4,500 g) increased significantly with increasing BMI (1.6, 2.2 and 2.7), as did the risks of having a neonate with a low Apgar score (1.3, 1.4 and 1.9) and having a stillborn fetus (1.4, 1.6 and 1.9).
Overall, this study underscores the need for health care providers to counsel overweight as well as obese women of childbearing age about the risks of excess weight during pregnancy; to discuss with them the need to initiate nutrition and activity measures to attempt to achieve a normal weight before conception occurs.
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