OBJECTIVE The purpose of this study was to determine the effect of maternal superobesity (body mass index [BMI], ≥50 kg/m2) compared with morbid obesity (BMI, 40–49.9 kg/m2) or obesity (BMI, 30–39.9 kg/m2) on perinatal outcomes. STUDY DESIGN We conducted a retrospective cohort study of birth records that were linked to hospital discharge data for all liveborn singleton term infants who were born to obese Missouri residents from 2000–2006. We excluded major congenital anomalies and women with diabetes mellitus or chronic hypertension. RESULTS There were 64,272 births that met the study criteria, which included 1185 superobese mothers (1.8%). Superobese women were significantly more likely than obese women to have preeclampsia (adjusted relative risk [aRR], 1.7; 95% confidence interval [CI], 1.4 –2.1), macrosomia (aRR, 1.8; 95% CI, 1.3–2.5), and cesarean delivery (aRR, 1.8; 95% CI, 1.5–2.1). Almost one-half of all superobese women (49.1%) delivered by cesarean section, and 33.8% of superobese nulliparous women underwent scheduled primary cesarean delivery. CONCLUSION Women with a BMI of ≥50 kg/m2 are at significantly increased risk for perinatal complications compared with obese women with a lower BMI.

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Objective To estimate the effect of race on perinatal outcomes in obese women. Methods Retrospective cohort study of birth records linked to hospital discharge data for all live born singleton infants ≥37 weeks gestation born to African-American or Caucasian Missouri residents from 2000 to 2006. We excluded major congenital anomalies and women with diabetes or chronic hypertension. Obesity was defined as pre-pregnancy body mass index ≥30 kg/m2. Results There were 312 412 births meeting study criteria. 27.1% (11 776) of African-American mothers and 19.1% (49 415) of Caucasian mothers were obese. There were no differences in cesarean delivery or preeclampsia between obese African-American and obese Caucasian women. Infants of obese African-American women were significantly less likely to be macrosomic (0.9% vs. 2.2%, adjusted odds ratio [aOR] 0.5, 95% confidence interval [CI] 0.4 0.6) and more likely to be low birth weight (3.4% vs. 1.8%, aOR 1.9, 95% CI 1.7, 2.2) compared to infants of obese Caucasian women. Compared to their normal weight peers, obese Caucasian women had a greater relative risk of developing preeclampsia (aOR 3.1, 95% CI 2.9, 3.2) than obese African-American women (aOR 2.1, 95% CI 1.9, 2.4). Conclusion Racial disparities impact obesity-related maternal and neonatal complications of pregnancy.

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Breech presentation at delivery is a marker for the presence of congenital anomaly. Infants delivered breech deserve special scrutiny for the presence of malformation.

OBJECTIVE-The purpose of this study was to determine the effect of maternal superobesity (body mass index [BMI], ≥50 kg/m 2 ) compared with morbid obesity (BMI,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49).9 kg/m 2 ) or obesity (BMI, kg/m 2 ) on perinatal outcomes.STUDY DESIGN-We conducted a retrospective cohort study of birth records that were linked to hospital discharge data for all liveborn singleton term infants who were born to obese Missouri residents from 2000-2006. We excluded major congenital anomalies and women with diabetes mellitus or chronic hypertension.RESULTS-There were 64,272 births that met the study criteria, which included 1185 superobese mothers (1.8%). Superobese women were significantly more likely than obese women to have preeclampsia (adjusted relative risk [aRR], 1.7; 95% confidence interval [CI], 1.4 -2.1), macrosomia (aRR, 1.8; 95% CI, 1.3-2.5), and cesarean delivery (aRR, 1.8; 95% CI, 1.5-2.1). Almost one-half of all superobese women (49.1%) delivered by cesarean section, and 33.8% of superobese nulliparous women underwent scheduled primary cesarean delivery.CONCLUSION-Women with a BMI of ≥50 kg/m 2 are at significantly increased risk for perinatal complications compared with obese women with a lower BMI. Keywords pregnancy outcome; superobesityThe obesity epidemic remains unabated in the United States. In 2007-2008 of American women who were 20-39 years old met obesity criteria (body mass index [BMI] ≥30 kg/m 2 ) 1 ; obesity is now an increasingly common and harmful pregnancy complication. Superobesity, as coined in the gastric bypass literature to describe patients who weigh ≥225% of ideal body weight, 2 represents individuals with a BMI of ≥50 kg/m 2 . The number of superobese individuals is growing 5 times faster than other obesity categories, 3 which means that healthcare providers increasingly will be challenged to accommodate their healthcare needs. Presented as a poster at the 31st annual meeting of the Society for Maternal-Fetal Medicine, San Francisco, CA, Feb. 7-12, 2011. NIH Public Access Obese women are more likely than normal weight women to experience preeclampsia, diabetes mellitus, cesarean delivery, fetal growth abnormalities, and stillbirth. 4 Although several studies compare obese women to normal-weight women, to date there have been limited studies on superobesity in pregnancy. [5][6][7] As the number of superobese pregnant women continues to rise, it is important to determine whether there is a "dose-response" relationship between the severity of maternal obesity and perinatal complications.The objective of this study was to determine the effect of maternal superobesity on perinatal outcomes compared with maternal obesity (BMI, 30-39.9 kg/m 2 ) and morbid obesity (BMI,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49).9 kg/m 2 ). We hypothesized that pregnancy in super-obese women, compared with obese and morbidly obese women, is associated with (1) increased risk of maternal complications of pregnancy, (2) greater risk of fetal growth abnormalities, and (3) grea...

Objective We sought to examine perinatal outcomes in women with a body mass index (BMI) of 25 kg/m2 comparing those whose weight gain met 2009 IOM guidelines to women meeting 1990 IOM guidelines. Methods This is a retrospective cohort study utilizing birth records linked to hospital discharge data for all term, singleton infants born to overweight, Missouri residents (2000–2006) with a BMI of 25 kg/m2. We excluded congenital anomalies, mothers with diabetes, hypertension, or previous cesarean delivery. Results Fourteen thousand nine hundred fifty-five women gained 25–35 lbs (1990 guidelines); 1.6% delivered low birth weight (LBW) infants and 1.1% delivered macrosomic infants. Eight thousand three hundred fifty women gained 15–25 lbs (2009 guidelines); 3.4% delivered LBW infants and 0.6% delivered macrosomic infants. Women who gained 15–25 lbs were 1.99 (95% CI 1.67, 2.38) times more likely to have a LBW infant and 0.59 (95% CI 0.40, 0.76) times less likely to deliver a macrosomic infant. Conclusion Limiting weight gain in women with a BMI of 25 kg/m2, per the 2009 guidelines, increases the risk of LBW deliveries and decreases the risk of macrosomia but does not reduce associated adverse perinatal outcomes. Further studies should explore the optimal weight gain to reduce these outcomes.

Objective To determine the effect of increasing maternal obesity, including superobesity (body mass index [BMI] ≥ 50 kg/m2), on perinatal outcomes in women with diabetes. Study Design Retrospective cohort study of birth records for all live-born nonanom-alous singleton infants ≥ 37 weeks’ gestation born to Missouri residents with diabetes from 2000 to 2006. Women with either pregestational or gestational diabetes were included. Results There were 14,595 births to women with diabetes meeting study criteria, including 7,082 women with a BMI > 30 kg/m2 (48.5%). Compared with normal-weight women with diabetes, increasing BMI category, especially superobesity, was associated with a significantly increased risk for preeclampsia (adjusted relative risk [aRR] 3.6, 95% confidence interval [CI] 2.5, 5.2) and macrosomia (aRR 3.0, 95% CI 1.8, 5.40). The majority of nulliparous obese women with diabetes delivered via cesarean including 50.5% of obese, 61.4% of morbidly obese, and 69.8% of superobese women. The incidence of primary elective cesarean among nulliparous women with diabetes increased significantly with increasing maternal BMI with over 33% of morbidly obese and 39% of superobese women with diabetes delivering electively by cesarean. Conclusion Increasing maternal obesity in women with diabetes is significantly associated with higher risks of perinatal complications, especially cesarean delivery.