Increasing Pre-pregnancy Body Mass Index and Pregnancy Outcomes in the United States

Abstract

Introduction: As many Americans are becoming overweight or obese, increased body mass index (BMI) is fast becoming normalized. There is a need for more research that highlights the association between prepregnancy obesity and adverse pregnancy outcomes.Aim: To determine the association between increasing pre-pregnancy BMI and adverse pregnancy outcomes.Methods: We utilized the United States Vital Statistics records to collate data on all childbirths in the United States between 2015 and 2019. We determined the association between increasing pre-pregnancy BMI and adverse pregnancy outcomes using multivariate analysis. Neonatal outcomes measures include the fiveminute Apgar score, neonatal unit admission, neonates receiving assisted ventilation > six hours, neonatal antibiotics use, and neonatal seizures. Maternal outcomes include cesarean section rate, mothers requiring blood transfusion, unplanned hysterectomy, and intensive care unit admission. In addition, we controlled for maternal parameters such as race/ethnicity, age, insurance type, and pre-existing conditions such as chronic hypertension and prediabetes. Other covariates include paternal race, age and education level, gestational diabetes mellitus, induction of labor, weight gain during pregnancy, gestational age at delivery, and delivery weight.Results: We studied 15,627,572 deliveries in the US Vital Statistics records between 2015 and 2019. Among these women, 3.36% were underweight, 43.19% were with a normal BMI, 26.34% were overweight, 14.73% were in the obese class I, 7.23% were in the obese class II, and 5.14% were in the obese class III. Increasing pre-pregnancy BMI was associated with significant adverse outcomes across all measures of maternal and neonatal outcomes. Conclusion:A strong association exists between increasing pre-pregnancy BMI and adverse maternal and neonatal outcomes. The higher risk of adverse pregnancy outcomes among overweight and obese women remained even after controlling for other traditional risk factors of adverse maternal and neonatal outcomes.

Determinantes sociais e de saúde na ocorrência do parto cesáreo

“…Em estudo anterior, o aumento do IMC pré-gestacional foi associado ao aumento das taxas de cesariana e a resultados maternos e perinatais adversos (Akinyemi et al, 2022). Alguns autores sugerem que esse aumento de parto cesáreo entre as mulheres com excesso de peso, se dar pela falta de contratilidade miometrial ou deposição de gordura pélvica (Poobalan et al, 2009) ou ainda, ao aumento da necessidade de induções, maior duração do trabalho de parto e maior dose de ocitocina nas gestantes obesas que tiveram trabalho de parto induzido (Pevzner et al, 2009), que também pode estar relacionado ao sofrimento fetal agudo (SFA), à distócia funcional e à desproporção céfalo-pélvica (DCP) (Conceição, 2010).…”

Does Obesity Influence Women’s Decision Making about the Mode of Delivery?

“…Obesity, especially with a BMI ≥ 40 kg/m 2 , is also an independent risk factor for surgical wound complications after CD [ 48 ]. Additionally, it increases the risk of hemorrhage, blood transfusion, unplanned hysterectomy, longer postpartum hospitalization and intensive unit care admission [ 49 , 50 ].…”