The impact of maternal BMI status on pregnancy outcomes with immediate short‐term obstetric resource implications: a meta‐analysis

Abstract

Summary Obesity is rising in the obstetric population, yet there is an absence of services and guidance for the management of maternal obesity. This systematic review aimed to investigate relationships between obesity and impact on obstetric care. Literature was systematically searched for cohort studies of pregnant women with anthropometric measurements recorded within 16‐weeks gestation, followed up for the term of the pregnancy, with at least one obese and one comparison group. Two researchers independently data‐extracted and quality‐assessed each included study. Outcome measures were those that directly or indirectly impacted on maternity resources. Primary outcomes included instrumental delivery, caesarean delivery, duration of hospital stay, neonatal intensive care, neonatal trauma, haemorrhage, infection and 3rd/4th degree tears. Meta‐analysis shows a significant relationship between obesity and increased odds of caesarean and instrumental deliveries, haemorrhage, infection, longer duration of hospital stay and increased neonatal intensive care requirement. Maternal obesity significantly contributes to a poorer prognosis for mother and baby during delivery and in the immediate post‐partum period. National clinical guidelines for management of obese pregnant women, and public health interventions to help safeguard the health of mothers and their babies are urgently required.

The maternal and fetal impacts of obesity and gestational diabetes on pregnancy outcome

“…16 There is a consistent association between raised pre-pregnancy maternal BMI and fetal macrosomia, regardless of the definition used (birthweight > 4.5 kg, >90th percentile or >2SD above the mean gestational age adjusted birthweight for the reference population). Additionally, obesity during pregnancy carries the greatest risk for birth of infants large for gestational age (LGA).…”

“…16 The risk of mothers entering pregnancy with established type 2 diabetes mellitus increases linearly with increasing BMI. 17 Raised pre-pregnancy BMI also produces an additional threefold risk of developing gestational diabetes (GDM).…”

“…29 Fetal macrosomia and LGA are surrogate risk factors for adverse pregnancy outcomes such as shoulder dystocia and fetal birth injury. 16,18,30 Immediate neonatal complications such as hypoglycaemia, hyperbilirubinaemia and respiratory distress syndrome are also associated with raised maternal BMI. 16 Infants born to overweight and obese mothers require admission to the neonatal intensive care unit more frequently than offspring of normal weight mothers, predominantly due to a higher incidence of preterm birth, meconium aspiration and shoulder dystocia.…”

Lived experiences of routine antenatal dietetic services among women with obesity: A qualitative phenomenological study

“…There are significantly increased associations with adverse outcomes for women and babies including congenital anomalies, perinatal mortality, macrosomia, gestational diabetes, maternal infections and preterm birth (Heslehurst et al, 2008;Stothard et al, 2009;Tennant et al, 2011;Lutsiv et al, 2015). In the UK, there are clinical guidelines to detect and manage co-morbidities associated with obesity (e.g.…”

Wealth gradient-based divergence in the prevalence of underweight among women by marital status in Quoc Oai district, Vietnam

“…Underweight should be managed in Asian women, as low body weight during childbearing years has been associated with health problems affecting both infants and mothers, including preterm birth [5], low birth weight [6,7] and retarded growth during childhood [8]. Additionally this can lead to poor psychological health [9], increased risks of chronic diseases in later life [10] and early mortality [11]. …”