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Am J Perinatol 2019; 36(10): 1023-1030
DOI: 10.1055/s-0038-1675624
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Gestational Weight Gain on Trial of Labor after Cesarean Success

Jenny Y. Mei
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California
,
Alexandra L. Havard
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California
,
Amanda J. Mularz
2   Obstetrix Medical Group of Houston, Houston, Texas
,
Melanie M. Maykin
3   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
,
Stephanie L. Gaw
3   Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California
› Author Affiliations
Further Information

Publication History

25 June 2018

20 September 2018

Publication Date:
30 November 2018 (online)

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Abstract

Objective Excessive gestational weight gain (GWG) has been associated with adverse pregnancy outcomes, including increased risk of cesarean delivery (CD). Data are limited on associations between GWG and outcomes in women undergoing trial of labor after cesarean (TOLAC). We aimed to investigate whether appropriate GWG impacts TOLAC outcomes.

Study Design We performed a retrospective cohort study of women undergoing TOLAC at a single institution from May 2007 to April 2016. Women were divided into three groups based on GWG as compared with the Institute of Medicine recommendations. The primary outcome was successful vaginal birth after cesarean (VBAC). Secondary outcomes included various perinatal morbidity markers.

Results A total of 614 women underwent TOLAC, of whom 444 (72.3%) had successful VBACs. When grouped by GWG in accordance with the Institute of Medicine guidelines, 149 (24.3%) women had GWG below guidelines, 224 (36.5%) met guidelines, and 241(39.3%) exceeded guidelines. There was no difference in the rate of VBAC success among the three groups. We also found no differences in secondary perinatal morbidity markers.

Conclusion We found no difference in TOLAC success rates with excess GWG. Providers should not consider excess GWG a risk factor for failed TOLAC, even in obese patients.

Keywords

vaginal birth after cesarean - gestational weight gain - obesity

Note

This study was presented in part in poster format at the Annual Clinical and Scientific Meeting of the American Congress of Obstetricians and Gynecologists, May 6–9, 2017, San Diego, CA.


 

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