Maternal Outcomes in Pregnancies Complicated by Obesity

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Abstract
OBJECTIVE: To investigate the relationship between prepregnancy obesity and maternal outcomes. METHODS: A 15-year, population-based cohort study using the Nova Scotia Atlee Perinatal Database compared maternal outcomes in obese and nonobese women. Prepregnancy weight of 55–75 kg was considered nonobese, and weight greater than 90 kg was considered obese. Obese women were categorized into moderate obesity (90–120 kg) and severe obesity (> 120 kg) groups. Univariate and multivariable logistic regression analysis was performed, and odds ratios (ORs), adjusted ORs, and 95% confidence intervals (CIs) were calculated. P < .05 was considered statistically significant. RESULTS: In 142,404 singleton pregnancies, 10,134 (7.2%) women were identified as obese (moderate obesity 92.3%, severe obesity 7.7%). The proportion of women in the obese categories increased from 3.2% in 1988 to 10.2% in 2002. Moderately obese women had an increased risk of pregnancy-induced hypertension (PIH) (adjusted OR 2.38, 95% CI 2.24–2.52), antepartum venous thromboembolism (adjusted OR 2.17, 95% CI 1.30–3.63), labor induction (adjusted OR 1.94, 95% CI 1.86–2.04), cesarean delivery (adjusted OR 1.60, 95% CI 1.53–1.67), and wound infection (adjusted OR 1.67, 95% CI 1.38–2.00). Severely obese women had an increased risk of PIH (adjusted OR 3.00, 95% CI 2.49–3.62), antepartum venous thromboembolism (adjusted OR 4.13, 95% CI 1.26–13.54), induction of labor (adjusted OR 2.77, 95% CI 2.39–3.21), cesarean delivery (adjusted OR 2.46, 95% CI 2.15–2.81), anesthesia complications (adjusted OR 2.01, 95% CI 1.33–3.06), and wound infection (adjusted OR 4.79, 95% CI 3.30–6.95). This implies that, relative to nonobese women, there was 1 excess case of PIH per 10 moderately obese women and 1 per 7 severely obese women. For antepartum venous thromboembolism, there was 1 excess case per 857 moderately obese women and 1 per 321 severely obese women. CONCLUSION: Prepregnancy maternal obesity increases the risk of PIH, antepartum venous thromboembolism, labor induction, cesarean delivery, and wound infection. LEVEL OF EVIDENCE: II-2

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