Trends in obesity and impact on obstetric outcomes in a regional hospital in Victoria, Australia

Ward, M; Agarwal, Anju; Bish, Melanie; James, Rachel; Faulks, Fiona; Pitson, Jennifer; Mnatzaganian, George

doi:10.1111/ajo.13035

Cited by 18 publications

(15 citation statements)

References 24 publications

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“…All study variables including socio-demographic, antenatal, intrapartum, postpartum and breast feeding data were collected from the Birthing Outcome System database, which is an electronic, hospital-based integrated data collection tool that facilitates longitudinal patient data recording. 12 All repeat births for women presenting more than once during the study period were included. The weight and height were measured by the midwife at the first antenatal appointment.…”

Section: Variablesmentioning

confidence: 99%

Relationship between obesity and lower rates of breast feeding initiation in regional Victoria, Australia: an 8-year retrospective panel study

et al. 2021

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ObjectivesUsing routinely collected hospital data, this study explored secular trends over time in breast feeding initiation in a large Australian sample. The association between obesity and not breast feeding was investigated utilising a generalised estimating equations logistic regression that adjusted for sociodemographics, antenatal, intrapartum and postpartum conditions, mode of delivery and infant’s-related covariates.DesignPopulation-based retrospective panel.SettingA regional hospital that serves 26% of Victoria’s 6.5 million population in Australia.ParticipantsAll women experiencing live births between 2010 and 2017 were included. Women with missing body mass index (BMI) were excluded.ResultsA total of 7491 women contributed to 10 234 live births. At baseline, 57.2% of the women were overweight or obese, with obesity increasing over 8 years by 12.8%, p=0.001. Although, breast feeding increased over time, observed in all socioeconomic status (SES) and BMI categories, the lowest proportions were consistently found among the obese and morbidly obese (78.9% vs 87.1% in non-obese mothers, p<0.001). In the multivariable analysis, risk of not breast feeding was associated with higher BMI, teenage motherhood, smoking, belonging to the lowest SES class, gravidity >4 and undergoing an assisted vaginal or caesarean delivery. Compared with women with a normal weight, the obese and morbidly obese were 66% (OR 1.66, 95% CI 1.40 to 1.96, p<0.001) to 2.6 times (OR 2.61, 95% CI 2.07 to 3.29, p<0.001) less likely to breast feed, respectively. The detected dose–response effect between higher BMI and lower breast feeding was not explained by any of the study covariates.ConclusionThis study provides evidence of increasing breast feeding proportions in regional Victoria over the past decade. However, these proportions were lowest among the obese and morbidly obese and those coming from the most disadvantaged backgrounds suggesting the need for targeted interventions to support breast feeding among these groups. The psychosocial and physiological associations between obesity and breast feeding should further be investigated.

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Section: Variablesmentioning

confidence: 99%

Relationship between obesity and lower rates of breast feeding initiation in regional Victoria, Australia: an 8-year retrospective panel study

et al. 2021

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“…The increased use of epidural analgesia has also been implicated to be associated with a prolonged second stage of labor. 29,30 These temporal changes may have an impact on the rates of OASIS. However, changes in clinical practices, such as decreased rates of instrumental deliveries, especially forceps deliveries, 17,31,32 and changes in the criteria for cesarean delivery may have favored a decrease in the rates of OASIS.…”

Section: Introductionmentioning

confidence: 99%

Temporal trends in the incidence of and associations between the risk factors for obstetrical anal sphincter injuries

Ekstein-Badichi

Shoham‐Vardi

Weintraub

2021

American Journal of Obstetrics & Gynecology MFM

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BACKGROUND: Obstetrical anal sphincter injuries are an important complication of vaginal deliveries that may result in short-and long-term pelvic floor morbidity and a diminished quality of life in young, healthy women. The prevalence of obstetrical anal sphincter injuries ranges from 0.1% to 8.7%. Over recent years, there seems to be a trend of increasing occurrence of obstetrical anal sphincter injuries worldwide. It is unclear why the rates are rising. Previous studies have examined the effect of different risk factors on the prevalence of obstetrical anal sphincter injuries. The change in the incidence of some risk factors for obstetrical anal sphincter injuries can partially explain the overall increase in obstetrical anal sphincter injuries. There is no previous study that explored the impact of the changes of individual risk factors over time on the risk for obstetrical anal sphincter injuries. OBJECTIVE: The main aim of this study was to examine the temporal trends in the prevalence and odds ratio of the major risk factors known to be associated with obstetrical anal sphincter injuries in the period from 1988 to 2016. STUDY DESIGN: This was a retrospective cohort study that included all women who underwent vaginal deliveries between 1988 and 2016 at a tertiary university medical center. The time intervals were divided into 4 periods (1988e1997, 1998e2007, 2008e2016, and the total time from 1988 to 2016) and the incidence of each risk factor was calculated for each time period. Correlation models and regression analysis were performed to examine the association between obstetrical anal sphincter injuries and the different risk factors over time. Furthermore, the trends in the odds ratios of the important risk factors over the time periods were evaluated using a multivariate regression analysis in which the primiparous women were separated from the multiparous women. RESULTS: During the study period, there were 295,668 vaginal deliveries. Of these, 591 women were diagnosed with obstetrical anal sphincter injuries (0.2%). The significant risk factors for obstetrical anal sphincter injuries (P<.05) in the multivariable analysis were the following: primiparity, vaginal birth after cesarean delivery, vacuum extraction, and a birthweight of >4 kg. There was a significant (P<.05) increase in the incidence over the study period for the following risk factors: primiparity, vaginal birth after cesarean delivery, and vacuum extraction. No change was found in the incidence of the risk factor of a birthweight of >4 kg. In addition, we found a strengthening of the association between vaginal birth after cesarean delivery and macrosomia with obstetrical anal sphincter injuries, as opposed to a decline in the relative contribution of vacuum extraction to the overall risk for obstetrical anal sphincter injuries. Moreover, we found that obstetrical anal sphincter injuries among primiparous women increased 7-fold over the study period but was unchanged among multiparous women. CONCLUSION: We have shown significant (P<.05) t...

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“…In the EU (2018), CS birth reached 1.4 million [5]. One factor shown to contribute to higher CS rates is maternal obesity [6][7][8], increasing incrementally for both elective and emergency CS with each body mass index (BMI) category [9]. Compared to women of normal weight, obese pregnant women, particularly those with morbid obesity, are more likely to present with co-morbidity and suffer obstetric complications [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…One factor shown to contribute to higher CS rates is maternal obesity [6][7][8], increasing incrementally for both elective and emergency CS with each body mass index (BMI) category [9]. Compared to women of normal weight, obese pregnant women, particularly those with morbid obesity, are more likely to present with co-morbidity and suffer obstetric complications [9,10]. In the postpartum period, surgical wound complications such as surgical site infection (SSI) [11] and wound dehiscence are rising [12], with significant impact on health care costs [13,14].…”

Section: Introductionmentioning

confidence: 99%

Abdominal Cutaneous Thermography and Perfusion Mapping after Caesarean Section: A Scoping Review

Childs

Soltani

2020

IJERPH

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Introduction: Caesarean section (CS) is the most prevalent surgical procedure in women. The incidence of surgical site infection (SSI) after CS remains high but recent observations of CS wounds using infrared thermography has shown promise for the technique in SSI prognosis. Although thermography is recognised as a ‘surrogate’ of skin perfusion, little is known of the relationship between skin temperature and skin perfusion in the context of wound healing. Aim: To assess the extent of literature regarding the application of infrared thermography and mapping of abdominal cutaneous perfusion after CS. Methods: Wide eligibility criteria were used to capture all relevant studies of any design, published in English, and addressing thermal imaging or skin perfusion mapping of the abdominal wall. The CINAHL and MEDLINE databases were searched, with two independent reviewers screening the title and abstracts of all identified citations, followed by full-text screening of relevant studies. Data extraction from included studies was undertaken using a pre-specified data extraction chart. Data were tabulated and synthesised in narrative format. Results: From 83 citations identified, 18 studies were considered relevant. With three additional studies identified from the reference lists, 21 studies were screened via full text. None of the studies reported thermal imaging and cutaneous perfusion patterns of the anterior abdominal wall. However, two observational studies partially met the inclusion criteria. The first explored analysis methodologies to ‘interrogate’ the abdominal thermal map. A specific thermal signature (‘cold spots’) was identified as an early ‘flag’ for SSI risk. A second study, by the same authors, focusing on obesity (a known risk factor for SSI after CS) showed that a 1 °C lower abdominal skin temperature led to a 3-fold odds of SSI. Conclusion: There is a significant gap in knowledge on how to forewarn of wound complications after CS. By utilising the known association between skin temperature and blood flow, thermographic assessment of the wound and adjacent thermal territories has potential as a non-invasive, independent, imaging option with which to identify tissue ‘at risk’. By identifying skin ‘hot’ or ‘cold’ spots, commensurate with high or low blood flow regions, there is potential to shed light on the underlying mechanisms leading to infective and non-infective wound complications.

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Trends in obesity and impact on obstetric outcomes in a regional hospital in Victoria, Australia

Cited by 18 publications

References 24 publications

Relationship between obesity and lower rates of breast feeding initiation in regional Victoria, Australia: an 8-year retrospective panel study

Relationship between obesity and lower rates of breast feeding initiation in regional Victoria, Australia: an 8-year retrospective panel study

Temporal trends in the incidence of and associations between the risk factors for obstetrical anal sphincter injuries

Abdominal Cutaneous Thermography and Perfusion Mapping after Caesarean Section: A Scoping Review

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