A conceptual framework for the impact of obesity on risk of cesarean delivery

Rogers, Anna Joy; Mari, Giancarlo

doi:10.1016/j.ajog.2018.06.006

Cited by 31 publications

(39 citation statements)

References 98 publications

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“…Independent risk factors for higher oxytocin requirements during labor induction including nulliparity, macrosomia, low Bishop score, maternal obesity, and/or maternal age > 35 years (Batinelli et al, 2018;Ellis et al, 2019) were either used as exclusion criteria, balanced in case/comparison groups, used as covariates in multivariate analyses, or not controlled in analyses if they occurred during labor induction as part of the causal pathway (Supplemental Table 1; Rogers et al, 2018;Snowden et al, 2018).…”

Section: Study Participantsmentioning

confidence: 99%

Metabolic Pathways Associated With Term Labor Induction Course in African American Women

Carlson

Frediani

Corwin

et al. 2020

Biological Research For Nursing

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Objectives: The purpose of this study was to evaluate differences in the metabolic pathways activated in late-pregnancy serum samples among African American women who went on to have term (≥37 weeks) labor induction requiring high total oxytocin doses to complete first-stage labor compared to those in similar women with low-oxytocin labor inductions. Study Design: Case–control study ( N = 27 women with labor induction with successful cervical ripening: 13 requiring the highest total doses of synthetic oxytocin to progress from 4- to 10-cm cervical dilation and 14 requiring the lowest total doses) with groups balanced on parity and gestational age. Serum samples obtained between 24 and 30 weeks’ gestation were analyzed using ultra-high-resolution metabolomics. Differentially expressed metabolites between high-oxytocin induction cases and low-oxytocin induction comparison subjects were evaluated using linear regression with xmsPANDA. Metabolic pathways analysis was conducted using Mummichog Version 2.0, with discriminating metabolites annotated using xMSannotator Version 1.3. Results: Labor processes were similar by group with the exception that cases received over 6 times more oxytocin between 4- and 10-cm cervical dilation than comparison women. Induction requiring high total doses of synthetic oxytocin was associated with late-pregnancy serum levels of metabolites from the linoleate and fatty acid activation pathways in term, African American women. Conclusion: Serum levels of several lipid metabolites predicted more complicated labor induction involving higher doses of synthetic oxytocin to complete first-stage labor. Further investigation in larger, more diverse cohorts of women is needed to identify potential targets to prevent failed labor induction.

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Section: Study Participantsmentioning

confidence: 99%

Metabolic Pathways Associated With Term Labor Induction Course in African American Women

Carlson

Frediani

Corwin

et al. 2020

Biological Research For Nursing

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“…First, potential differences in labor duration that could potentially be caused by differences in labor management were offset in this study by our focus on participants who were managed by the same team of physicians and midwives following the same protocols across two hospitals. 42 Another strength of this study is our careful consideration of variables known to associate with the duration of labor in our choice of inclusion/exclusion criteria, case-control group assignment, and statistical covariates. A range of factors can affect labor progress, including maternal age, 90 BMI, 13 maternal parity, 11 and mode of labor onset.…”

Section: Discussionmentioning

confidence: 99%

“…Independent risk factors for labor dystocia were either used as exclusion criteria, balanced in case-control groups, used as covariates in multivariate analyses, or not controlled in analyses if they occurred during active phase labor as part of the causal pathway (►Supplementary Table 1). 42,43 Frequencies and percentages were calculated for categorical variables describing maternal demographic, pregnancy, and labor characteristics across case-control groups; continuous data were assessed using median and interquartile range (non-normal distribution) or mean and standard deviation (normal distributions). Mann-Whitney U test or t-tests were used for continuous data and likelihood ratio tests for categorical data.…”

Section: Study Participantsmentioning

confidence: 99%

Metabolomic Pathways Predicting Labor Dystocia by Maternal Body Mass Index

Carlson

Frediani

Corwin

et al. 2020

AJP Rep

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Objectives The purpose of this study was to evaluate the metabolic pathways activated in the serum of African-American women during late pregnancy that predicted term labor dystocia. Study Design Matched case–control study (n = 97; 48 cases of term labor dystocia and 49 normal labor progression controls) with selection based on body mass index (BMI) at hospital admission and maternal age. Late pregnancy serum samples were analyzed using ultra-high-resolution metabolomics. Differentially expressed metabolic features and pathways between cases experiencing term labor dystocia and normal labor controls were evaluated in the total sample, among women who were obese at the time of labor (BMI ≥ 30 kg/m2), and among women who were not obese. Results Labor dystocia was predicted by different metabolic pathways in late pregnancy serum among obese (androgen/estrogen biosynthesis) versus nonobese African-American women (fatty acid activation, steroid hormone biosynthesis, bile acid biosynthesis, glycosphingolipid metabolism). After adjusting for maternal BMI and age in the total sample, labor dystocia was predicted by tryptophan metabolic pathways in addition to C21 steroid hormone, glycosphingolipid, and androgen/estrogen metabolism. Conclusion Metabolic pathways consistent with lipotoxicity, steroid hormone production, and tryptophan metabolism in late pregnancy serum were significantly associated with term labor dystocia in African-American women.

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“…The prevalence of overweight and obesity among women of reproductive age is in-creasing in many countries [ 15 , 16 ], with some reporting higher prevalence among pregnant migrant women compared to pregnant non-migrant women [ 17 , 18 , 19 ]. A high pre-pregnancy body mass index (BMI) is a known risk factor for CS [ 20 , 21 ], especially for the emergency type [ 22 ]. Overweight or obese women who have a CS experience more adverse outcomes when compared to normal weight women with a CS or obese women with a vaginal delivery [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Association between Maternal Origin, Pre-Pregnancy Body Mass Index and Caesarean Section: A Nation-Wide Registry Study

Jatta

Sundby

Vangen

et al. 2021

IJERPH

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Aims: To explore the association between maternal origin and birthplace, and caesarean section (CS) by pre-pregnancy body mass index (BMI) and length of residence. Methods: We linked records from 118,459 primiparous women in the Medical Birth Registry of Norway between 2013 and 2017 with data from the National Population Register. We categorized pre-pregnancy BMI (kg/m2) into underweight (<18.5), normal weight (18.5–24.9) and overweight/obese (≥25). Multinomial regression analysis estimated crude and adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) for emergency and elective CS. Results: Compared to normal weight women from Norway, women from Sub-Saharan Africa and Southeast Asia/Pacific had a decreased risk of elective CS (aRRR = 0.57, 95% CI 0.37–0.87 and aRRR = 0.56, 0.41–0.77, respectively). Overweight/obese women from Europe/Central Asia had the highest risk of elective CS (aRRR = 1.42, 1.09–1.86). Both normal weight and overweight/obese Sub-Saharan African women had the highest risks of emergency CS (aRRR = 2.61, 2.28-2.99; 2.18, 1.81-2.63, respectively). Compared to women from high-income countries, the risk of elective CS was increasing with a longer length of residence among European/Central Asian women. Newly arrived migrants from Sub-Saharan Africa had the highest risk of emergency CS. Conclusion: Women from Sub-Saharan Africa had more than two times the risk of emergency CS compared to women originating from Norway, regardless of pre-pregnancy BMI.

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A conceptual framework for the impact of obesity on risk of cesarean delivery

Cited by 31 publications

References 98 publications

Metabolic Pathways Associated With Term Labor Induction Course in African American Women

Metabolic Pathways Associated With Term Labor Induction Course in African American Women

Metabolomic Pathways Predicting Labor Dystocia by Maternal Body Mass Index

Association between Maternal Origin, Pre-Pregnancy Body Mass Index and Caesarean Section: A Nation-Wide Registry Study

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