The impact of maternal obesity on intra-partum events during pregnancy: a retrospective study at Puducherry

Abstract

INTRODUCTIONObesity is a modern-day national epidemic which affects all ages and gender in our country which has not spared women of reproductive age also.1 Women with excessive weight at the time of conception not only have health problems during gestation and at the time of delivery, but also during the post-partum period.2 Various studies done in many parts of the world have demonstrated that obesity in pregnancy is associated with a wide spectrum of adverse pregnancy outcomes including major postpartum haemorrhage, increased caesarean section rates, increased operational vaginal deliveries, higher risks of maternal hypertension, gestational diabetes and fetal death.3-6 A study done in urban area of Puducherry showed the prevalence of overweight was 41.4% and of obesity was 4.5%. 7 Another study done in rural areas of Puducherry showed that 27.7% of the women participants had a BMI>25.8 This shows that there is an anticipated increased risk of obesity inflicted maternal adverse outcomes among women in Puducherry. A healthy dietary plan and physical activity schedule prior to conception can be a useful pre-requisite for women who are obese to save themselves from adverse obesity-related complications during pregnancy. On the other hand, a profile of incident adverse outcomes in obese women during delivery would be useful for obstetricians to anticipate and avert risks in intra-partum period. Hence this study aims at studying the impact of maternal obesity on the various maternal outcomes during pregnancy by ABSTRACT Background: Women with excessive weight at the time of conception are prone to a wide spectrum of adverse pregnancy outcomes including major postpartum haemorrhage, increased caesarean section rates, increased operational vaginal deliveries and higher risks of maternal hypertension, gestational diabetes and fetal death. Methods: This retrospective case-control study was conducted at a tertiary care hospital in Ariyur, Puducherry by comparing 100 obese women (cases) with 100 Non-obese, normal weighted women (controls) in terms their intrapartum pregnancy events and outcomes. Results: Obese women (42%) had an increased risk of having a caesarean section (OR 2.57, 95% CI 1.31-5.1) when compared to the controls (22%). Instrumental delivery rate was significantly higher (p=0.02) in the study group (24%) compared to 11% in the control group (OR 2.56, 95% CI 1.1-6.1). Postpartum haemorrhage (>500 ml) encountered during vaginal deliveries was 32% in the obese group which was significantly higher (p<0.001) when compared with 9% in the control group (OR 4.76, 95% CI 2-12). Conclusions: Obese women had increased incidence of difficult intra-partum events like increased blood loss and post-partum haemorrhage, increased requirement of oxytocin augmentation, higher rates of caesarean and instrumental deliveries, when compared to non-obese women.