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Am J Perinatol 2026; 43(02): 222-229
DOI: 10.1055/a-2600-7069
Original Article

Postpartum Hemorrhage Morbidity in Deliveries Complicated by Elevated Body Mass Index

Autor*innen

  • Hailie Ciomperlik

    1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas

  • Rachel L. Wiley 

    2   Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California

  • Ipsita Ghose

    1   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas

  • Anna Whelan 

    3   Department of Obstetrics and Gynecology, UMass Chan Medical School, Worcester, Massachusetts

  • Hector Mendez-Figueroa

    4   Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas

  • Suneet P. Chauhan

    5   Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, Delaware

Funding None.
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Abstract

Objective

The relationship between body mass index (BMI) ≥ 30 in pregnancy and postpartum hemorrhage (PPH) has been unclear. While some risk stratification protocols classify elevated BMI as a moderate risk factor others do not. This study aimed to examine the effect of elevated BMI on PPH in a contemporary population.

Study Design

This retrospective cohort study included all singletons ≥14 weeks with recorded BMI who delivered at a Level IV center for two consecutive years. The exposure group was sub-categorized into BMI of 30 to 39.9 and BMI ≥ 40 kg/m2, with a planned subgroup by mode of delivery. Data was collected by clinicians, and the composite maternal hemorrhagic outcome (CMHO) was defined as: blood loss ≥ 1,000 mL, interventions for atony including use of uterotonics (excluding prophylactic oxytocin), mechanical tamponade, surgical intervention, venous thromboembolism, admission to the intensive care unit, hysterectomy, or maternal death. Adjusted relative risks (aRR) with 95% confidence intervals (CI) were calculated using multivariate Poisson regression with robust error variance.

Results

Of 8,623 deliveries in the study period, 8,340 (96.7%) met inclusion criteria, with 2,943 (35%) with BMI < 30.0, 3,900 (46%) with BMI of 30 to 39.9 kg/m2, and 1,497 (17%) with BMI of ≥40 kg/m2. CHMO was increased for BMI of 30 to 39.9 (aRR: 1.16; 95% CI: 1.04–1.29) and ≥40.0 (aRR: 1.19; 95% CI: 1.04–1.36), largely due to increased risk of blood loss ≥ 1,000 and uterotonic use. A subgroup analysis by mode of delivery noted that increased risk for CHMO was only present in BMI ≥ 40 for vaginal deliveries (aRR: 1.35; 95% CI: 1.10–1.65) and only for BMI of 30 to 39.9 in cesarean delivery (aRR: 1.28; 95% CI: 1.10–1.50).

Conclusion

Parturients with BMI ≥ 30 had a higher risk of hemorrhage-related morbidity compared with patients with BMI < 30, however, clinical management and impact need further investigation.

Key Points

  • Patients with an elevated BMI had a higher risk of hemorrhage-related morbidity.

  • Individuals with BMI ≥ 40 kg/m2 are at increased risk of hemorrhage with vaginal deliveries.

  • With rising BMI rates, research on perinatal risks and targeted interventions is crucial for better.

Keywords

obesity - postpartum hemorrhage - transfusion - labor - uterotonics


Publikationsverlauf

Eingereicht: 01. April 2025

Angenommen: 05. Mai 2025

Accepted Manuscript online:
07. Mai 2025

Artikel online veröffentlicht:
10. Juni 2025

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