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Am J Perinatol 2015; 32(14): 1298-1304
DOI: 10.1055/s-0035-1563717
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Maternal Obesity Class as a Predictor of Induction Failure: A Practical Risk Assessment Tool

Stefania Ronzoni
1   Division of Feto Maternal Medicine, Department of Obstetric and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
,
Hadar Rosen
1   Division of Feto Maternal Medicine, Department of Obstetric and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
,
Nir Melamed
2   Division of Feto Maternal Medicine, Department of Obstetric and Gynecology, Sunnybrook Health Science Center, University of Toronto, Toronto, Ontario, Canada
,
Shay Porat
3   Department of Obstetrics and Gynecology, Hadassah-Hebrew, University Medical Center, Mt Scopus Campus, Jerusalem, Israel
,
Dan Farine
1   Division of Feto Maternal Medicine, Department of Obstetric and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
,
Cynthia Maxwell
1   Division of Feto Maternal Medicine, Department of Obstetric and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
› Author Affiliations
Further Information

Publication History

15 July 2015

21 July 2015

Publication Date:
09 September 2015 (online)

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Abstract

Objective To assess the impact of body mass index (BMI) on the rate of cesarean section (rCS) in induction of labor (IOL).

Study Design A total of 7,543 singleton term pregnancies undergoing IOL (cervical dilatation at admission, CDA ≤ 3 cm) were divided according to BMI: underweight (n = 325); normal weight (NW) (n = 4,633); overweight (OW) (n = 1,610); and obese (n = 975). Age, parity, macrosomia, gestational age (GA), gestational weight gain (GWG), CDA, and IOL indications were considered.

Results A higher rate of macrosomia (15.0 vs. 11.1%; p < 0.0001), earlier induction (GA 39.7 ± 1.3 vs. 40.1 ± 1.3 weeks; p < 0.0001) for maternal indications (39.1 vs. 21.1%; p < 0.001), and lower CDA (≤1cm; 66.4 vs. 61.4%; p < 0.005) were observed in obese versus NW. The rate of weight gain above the recommended range was higher in obese (obese 70.6% vs. NW 43.9%; p < 0.001), despite a significantly lower mean GWG compared with NW (14 ± 7.5 vs. 16.5 ± 5.6 kg; p < 0.001). Compared with NW, OW and obese demonstrated a significantly higher rCS (OW 31.1% and obese 36.9% vs. NW 24.7%; p < 0.001). BMI represented an independent factor affecting the rCS (vs. NW; OW odds ratio [OR] 1.4; confidence interval [CI] 1.2–1.7; p < 0.001; obese OR 2.3; CI 1.9–2.7 p < 0.001).

Conclusion In the case of IOL, obesity represents an independent factor associated with a significant increase of CS to be considered during induction counselling.

Keywords

body mass index - cesarean section - induction of labor - obesity

Note

Findings presented at SMFM 35th Annual Meeting—The Pregnancy Meeting, San Diego, CA, February 2–7, 2015, Abstract #229.