Risks of Maternal Obesity in Pregnancy: A Case-control Study in a Portuguese Obstetrical Population

Abstract

Objective The present study aims to understand to what extent obesity is related to adverse maternal, obstetrical, and neonatal outcomes in a Portuguese obstetrical population.

Methods A retrospective case-control study was conducted at the Department of Obstetrics of a differentiated perinatal care facility. The study compared 1,183 obese pregnant women with 5,399 normal or underweight pregnant women for the occurrence of gestational diabetes, hypertensive pregnancy disorders, and preterm birth. Mode of delivery, birthweight, and neonatal intensive care unit (ICU) admissions were also evaluated. Mean blood glucose values were evaluated and compared between groups, in the first and second trimesters of pregnancy. Only singleton pregnancies were considered.

Results The prevalence of obesity was 13.6%. Obese pregnant women were significantly more likely to have cesarean sections (adjusted odds ratio [aOR] 2.0, p < 0.001), gestational diabetes (aOR 2.14, p < 0.001), hypertensive pregnancy disorders (aOR 3.43, p < 0.001), and large-for-gestational age or macrosomic infants (aOR 2.13, p < 0.001), and less likely to have small-for-gestational age newborns (aOR 0.51, p < 0.009). No significant differences were found in terms of preterm births, fetal/neonatal deaths, low birthweight newborns, and neonatal ICU admissions among cases and controls. Maternal obesity was significantly associated with higher mean blood glucose levels, in the first and second trimesters of pregnancy.

Conclusion Obesity is associated with increased risks of adverse pregnancy and neonatal outcomes. These risks seem to increase progressively with increasing body mass index (BMI) class. Female obesity should be considered a major public health issue and has consequences on maternal-fetal health.

Resumo

Objetivo O presente estudo pretende avaliar em que medida a obesidade influencia os desfechos maternos, obstétricos e neonatais em uma população obstétrica portuguesa.

Métodos Um estudo caso-controle retrospectivo foi realizado no departamento de obstetrícia de um centro perinatal diferenciado. O estudo comparou 1.183 grávidas obesas com 5.399 grávidas normoponderais ou com baixo peso para a ocorrência de diabetes gestacional, doenças hipertensivas da gravidez e parto pré-termo. Via de parto, peso ao nascimento e admissão na unidade de cuidados neonatais também foram avaliados. Os valores glicêmicos médios foram avaliados e comparados entre os dois grupos, no primeiro e segundo trimestres de gravidez. Apenas as gravidezes unifetais foram avaliadas.

Resultados A prevalência da obesidade foi de 13.6%. As grávidas obesas tiveram risco significativamente superior a ter uma cesariana (odds ratio ajustado [Ora] 2.0, p < 0.001), diabetes gestacional (ORa 2.14, p < 0.001), doenças hipertensivas da gravidez (ORa 3.43, p < 0.001), recém-nascidos grandes para a idade gestacional ou macrossômicos (ORa 2.13, p < 0.001) e menor probabilidade de ter recém-nascidos pequenos para a idade gestacional (ORa 0.51, p < 0.009). Não houve diferença estatisticamente significativa quanto aos partos pré-termo, mortes fetais/neonatais, baixo peso ao nascer e admissão à unidade de cuidados intensivos neonatais. O odds ratio foi ajustado para a idade, número de gestações, paridade, ganho ponderal, doenças hipertensivas da gravidez e diabetes gestacional. A obesidade materna esteve significativamente associada a valores glicêmicos médios superiores, no primeiro e segundo trimestres de gravidez.

Conclusão A obesidade está associada a maior risco de desfechos adversos na gravidez e neonatais. Este risco parece aumentar progressivamente com o aumento do índice de massa corporal (IMC). A obesidade feminina deve ser considerada um importante problema de saúde pública e que tem repercussões na saúde materno-fetal.

Keywords

cesarean section - diabetes gestational - fetal macrosomia - obesity - high-risk pregnancy

Descritores

cesariana - diabetes gestacional - macrossomia fetal - obesidade - gravidez de alto risco

Contributions

All of the the authors contributed to the conception of the work and data collection. The analysis and interpretation of data was done by Alves P., Ferraz T., Malheiro M. F. and Gomes J. C.. The initial writing of the article was made by Alves P., Ferraz T. and Malheiro M. F. and was reviewed by Professor Montenegro N. and Gomes J. C.. All of the authors approved the final version of the article.

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