The impact of maternal obesity on intrapartum outcomes in otherwise low risk women: secondary analysis of the Birthplace national prospective cohort study. (11th September 2013)

• Record Type: Journal Article
• Authors: Hollowell, J; Pillas, D; Rowe, R; Linsell, L; Knight, M; Brocklehurst, P
• Is Part Of: BJOG. Volume 121:Number 3(2014:Mar.)
• Page Start: 343
• Page End: 355
• Publication Date: 2013-09-11
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12437
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12437-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12437-sec-0001" sec-type="section"> <title>Objectives</title> <p>To evaluate the impact of maternal BMI on intrapartum interventions and adverse outcomes that may influence choice of planned birth setting in healthy women without additional risk factors.</p> </sec> <sec id="bjo12437-sec-0002" sec-type="section"> <title>Design</title> <p>Prospective cohort study.</p> </sec> <sec id="bjo12437-sec-0003" sec-type="section"> <title>Setting</title> <p>Stratified random sample of English obstetric units.</p> </sec> <sec id="bjo12437-sec-0004" sec-type="section"> <title>Sample</title> <p>17 230 women without medical or obstetric risk factors other than obesity.</p> </sec> <sec id="bjo12437-sec-0005" sec-type="section"> <title>Methods</title> <p>Multivariable log Poisson regression was used to evaluate the effect of BMI on risk of intrapartum interventions and adverse maternal and perinatal outcomes adjusted for maternal characteristics.</p> </sec> <sec id="bjo12437-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Maternal intervention or adverse outcomes requiring obstetric care (composite of: augmentation, instrumental delivery, intrapartum caesarean section, general anaesthesia, blood transfusion, 3rd/4th degree perineal tear); neonatal unit admission or perinatal death.</p> </sec> <sec id="bjo12437-sec-0007" sec-type="section"> <title>Results</title> <p>In otherwise healthy women, obesity was associated with an increased risk of augmentation, intrapartum caesarean section and some adverse maternal outcomes but when interventions and outcomes requiring obstetric care were considered together, the magnitude of the increased risk was modest (adjusted RR 1.12, 95% CI 1.02–1.23, for BMI > 35 kg/m<sup>2</sup> relative to low risk women of normal weight). Nulliparous low risk women of normal weight had higher absolute risks and were more likely to require obstetric intervention or care than otherwise healthy multiparous women with BMI > 35 kg/m<sup>2</sup> (maternal composite outcome: 53% versus 21%). The perinatal composite outcome exhibited a similar pattern.</p> </sec> <sec id="bjo12437-sec-0008" sec-type="section"> <title>Conclusions</title> <p>Otherwise healthy multiparous obese women may have lower intrapartum risks than previously appreciated. BMI should be considered in conjunction with parity when assessing the potential risks associated with birth in non‐obstetric unit settings.</p> </sec> </abstract>