Impact of Maternal Obesity on Obstetrical Outcome

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 806-823-Gestational Diabetes
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-820
Lena Salgado*1, Thi Hoang Lan Nguyen1, Ji Wei Yang1, Patricia Lecca1, Catherine Adam1, Marie-Josée Bédard2 and Ariane Godbout1
1Centre de Recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada, 2Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
Background: Maternal obesity and excessive gestational weight gain (GWG) are correlated to poor pregnancy outcomes. Detailed data about obstetrical complication rates are needed for better preconception and antepartum counselling in obese population. Objective: To establish local complication rates among obese diabetic and non-diabetic pregnant women according to their pre-pregnancy body mass index (BMI) in order to identify preventive strategies in this high risk population. Methods: A retrospective population-based study was carried out among pregnant women who gave birth in our center in 2011. Women in whom weight or height was not recorded were excluded. Pregnancy outcomes of obese (BMI ≥30), overweight (25≤ BMI ˂30) and non-obese (BMI ˂25) subgroups were compared. Incidences of diabetes, gestational diabetes mellitus (GDM), macrosomia (defined as birth weight (BW) ≥4kg and as large for gestational age (LGA) if BW ≥90th percentile), intra-uterine growth restriction, hypertension, preeclampsia/eclampsia, prematurity, caesarean C-section (CS) and fetal distress were analyzed. BMI was calculated using weight recorded just before or at the very beginning of pregnancy. Results: A total of 1032 women were reviewed and 303 with available BMI values were included. Prior to pregnancy, 9.6% were underweight, 42.6% had a normal BMI, 21.8% were overweight and 26.1%, obese (BMI 30-35: 16.5%; 35-40: 5.3%; ≥40: 4.3%). Even after excluding diabetic patients, complication rates were increased in the obese cohort for preeclampsia (7.1 vs 1.4%; OR 5.4), CS (OR 2.3; by BMI classes: ˂20: 0%; 20-25: 19.3%; 25-30: 16.7%; 30-35: 31.3%; 35-40: 20%; ≥40: 28.6%), and macrosomia (BW ≥4kg: OR 5.8; by BMI: ˂20: 5.9%; 20-25: 5.3%; 25-30: 13.3%; 30-35: 31.3%; 35-40: 20%; ≥40: 14.3%) (LGA: 8.1 vs 17.9%; OR 2.5). No difference was noted for other complications. However, the mean GWG in obese mothers of macrosomic newborns was excessive (10 kg) considering the Institute of Medicine guidelines. Preeclampsia, CS and macrosomia rates were even more pronounced when diabetic patients were included, since GDM was more prevalent in the obese population. Conclusion: This study demonstrated a significant proportion of overweight and obese women in our population (47.9%). Obesity was associated to an increase in macrosomia, preeclampsia and CS rates, regardless of the incidence of GDM. All obese patients would benefit from preconception counselling for weight reduction and closer follow-up of GWG during pregnancy.

(1)  R. Gilead et al. Maternal “isolated” obesity and obstetric complications. J Matern Fetal Neonatal Med, 2012; 25(12): 2579–2582. (2)  J. Ramachenderan et al. Maternal obesity and pregnancy complications: A review. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, 2008; 48: 228–235. (3)  R. Khan. Morbid obesity in pregnancy: a review. Curr Opin Obstet Gynecol 2012; 24:382–386. (4)  D. Vinayagam and E. Chandraharan. The Adverse Impact of Maternal Obesity on Intrapartum and Perinatal Outcomes. Obstetrics and Gynecology, 2012; 2012.

Nothing to Disclose: LS, THLN, JWY, PL, CA, MJB, AG

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