Impact of Obesity on Pregnancy Outcome in Different Ethnic Groups: Calculating Population Attributable Fractions

Abstract

ObjectivesTo quantify the proportion of adverse pregnancy outcome attributable to maternal obesity.DesignCross sectional analysis of routine obstetric dataset.SettingGuy’s and St Thomas’s NHS Foundation Trust (GSTFT).Population23,668 women who had singleton deliveries at GSTFT between 2004 and 2008.MethodsLogistic regression was used to estimate the association between BMI and outcome in different ethnic groups. Adjusted odds ratios, and the proportions of obese women, were used to calculate population attributable risk fractions (PAFs).Main Outcome Measures(i) Maternal outcomes: diabetes, type of delivery, post-partum haemorrhage, and preterm delivery. (ii) Perinatal outcomes: macrosomia, low birth weight, admission to neonatal intensive care/special care baby unit, and perinatal death.ResultsThe prevalence of maternal obesity was 14%. Increasing BMI was independently associated with increasing risk of adverse obstetric and neonatal outcome. At the individual level, the effect of obesity on diabetes was highest in Asian women compared to white women (p for interaction = 0.03). Calculation of population attributable risk fractions demonstrated that one third of diabetes cases and one in six Caesarean sections could be avoided in this population if all obese women were of normal BMI. At the population level, the contribution of obesity to diabetes was highest for Black women (42%), and lowest for oriental women (8%). Seven percent of neonatal macrosomia in all the population, and 13% in Black mothers, were attributable to obesity.ConclusionsPreventing obesity prior to pregnancy will substantially reduce the burden of obstetric and neonatal morbidity in this population. This reduction will be higher in Black women.

Maternal heart rate during the first 48 h postpartum: a retrospective cross sectional study

“…Thus, with the greater 217 complication risk during pregnancy associated with maternal obesity, obese women with 218 unexplained tachycardia should still be investigated at the same thresholds as non-obese women 219 (23)(24)(25). This is pertinent given the association obesity has with maternal mortality and 220 cardiovascular disease (26,27).…”

“…Central tendency for heart rate at each time period postpartum (6,12,24 and 48 hours) was 117 calculated using the mea μ . Spread as calculated usi g standard deviation (SD) and suggested 118 normal range upper thresholds were calculated using the mean in addition to two and three 119 sta dard de iatio s μ+ SD, μ+ SD).…”

Pregnancy adverse outcomes related to pregravid body mass index and gestational weight gain, according to the presence or not of gestational diabetes mellitus: A retrospective observational study

“…First, it is a risk factor for GDM [2,3]. Second, it shares complications with GDM, such as large-for-gestational-age (LGA) infants [4][5][6][7][8][9][10][11], caesarean section [4,5,7,8,11,12], hypertensive disorders [4,5,7,8] and, in certain studies, shoulder dystocia [5]. Also, gestational weight gain (GWG) appears to be crucial [5,[8][9][10]13,14].…”

Epidemiología de las estrías gravídicas en España

“…En el análisis de este estudio se identificó que el sobrepeso y la obesidad previos al embarazo aumentan de forma significativa el riesgo de desarrollar estrías. Por ello, sería importante recomendar a las mujeres la pérdida de peso previa a la concepción, no solo para disminuir la aparición de estrías, sino también para intentar reducir otros riesgos maternofetales ya conocidos en la gestante con sobrepeso/obesidad 19 .…”