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.

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

Summary
Despite numerous studies reporting an increased risk of cesarean delivery among overweight or obese compared with normal weight women, the magnitude of the association remains uncertain. Therefore, we conducted a meta-analysis of the current literature to provide a quantitative estimate of this association. We identified studies from three sources: (i) a PubMed search of relevant articles published between January 1980 and September 2005; (ii) reference lists of publications selected from the search; and (iii) reference lists of review articles published between 2000 and 2005. We included cohort designed studies that reported obesity measures reflecting pregnancy body mass, had a normal weight comparison group, and presented data allowing a quantitative measurement of risk. We used a Bayesian random effects model to perform the meta-analysis and meta-regression. Thirty-three studies were included. The unadjusted odd ratios of a cesarean delivery were 1.46 [95% confidence interval (CI): 1.34–1.60], 2.05 (95% CI: 1.86–2.27) and 2.89 (95% CI: 2.28–3.79) among overweight, obese and severely obese women, respectively, compared with normal weight pregnant women. The meta-regression found no evidence that these estimates were affected by selected study characteristics. Our findings provide a quantitative estimate of the risk of cesarean delivery associated with high maternal body mass.

Maternal obesity and risk of cesarean delivery: a meta-analysis.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(03)14896-9.pdf

Caesarean section and risk of unexplained stillbirth in subsequent pregnancy

Maternal prepregnancy overweight and obesity and the pattern of labor progression in term nulliparous women

The objective of the study was to investigate the association between increasing maternal body mass index (BMI) and elective/emergency caesarean delivery rates. Systematic review and meta-analysis of published cohort studies were used. The bibliographic databases, MEDLINE, EMBASE, CINAHL, were searched systematically, with no language restrictions, from 1996 to May 2007. MeSH terms and key words for ‘pregnancy’, ‘obesity’, ‘overweight,’‘body mass index’ and ‘caesarean section’ were combined with the Cochrane Collaboration strategy for identifying primary studies. Finally, 11 papers were considered eligible for inclusion in the review. Although all the papers were cohort studies, only three were prospective in nature. Compared with women with normal BMI (20–25 kg m−2), the crude pooled odds ratios (95% confidence intervals) for caesarean section in overweight (BMI 25–30 kg m−2), obese (BMI 30–35 kg m−2) and morbidly obese (BMI > 35 kg m−2) women were 1.53 (1.48, 1.58), 2.26 (2.04, 2.51) and 3.38 (2.49, 4.57) respectively. The pooled odds of having an emergency caesarean section were 1.64 (95% confidence intervals 1.55, 1.73) in overweight and 2.23 (2.07, 2.42) in obese women. Caesarean delivery risk is increased by 50% in overweight women and is more than double for obese women compared with women with normal BMI.

Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women--systematic review and meta-analysis of cohort studies.

Background. To investigate the influence of Body Mass Index on the incidence of labor complications in a population of women with a normal pregnancy. Material and methods. From a local database, information on maternal weight and height was extracted concerning 4258 women who had an uncomplicated pregnancy. After calculation and stratification with respect to Body Mass Index, this was retrospectively related to labor interventions and complications. Results. High Body Mass Index was related to more oxytocin infusion and early amniotomy, but not to vacuum extraction or cesarean section. Primary inertia and, to a minor degree, cephalopelvic disproportion and secondary inertia were seen more often in women with high Body Mass Index. Conclusions. Overweight (25.0 =30.0) are only weak predictors of labor complications, given a normal pregnancy. However, the heavy use of labor augmentation indicates that obese women should not be recommended to give birth in an ABC-clinic or at home.

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1034/j.1600-0412.1999.780911.x

The influence of prepregnancy body mass index on labor complications.

C Acta Obstet Gynecol Scand 77 (1998) weight woman (19.9∞BMI∞25.0) matching for age (π/a2 years), parity (primi-/multipara), gestational age (∞37 gestational weeks/±Ω37 gestational weeks), duration of ruptured membranes before delivery (more/less than 12 hours) and type of cesarean section (emergency/elective), was selected as control for each case patient. Information about peror postoperative complications was extracted directly from the database, while information about the incision and preoperative antibiotics were found by record review. Peroperative blood loss was registered as estimated by the surgeon. Puerperal fever was defined as a rectal temperature of 38.5æC or more during at least 8 hours or a clinical picture with fever necessitating antibiotic treatment, without an extragenital focus. Wound infection was defined as redness or swelling requiring antibiotics. Cystitis was defined as a positive culture or subjective symptoms and presence of leucocytes or nitrite in the urine. The results were compared using chi-square test and, when appropriate, Fischer’s exact test.

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1034/j.1600-0412.1998.770715.x

Hanne Jensen

Papers

The influence of prepregnancy body mass index on labor complications.

Morbidity after cesarean section in obese women.

Morbidity after cesarean section in obese