Download PDF
Am J Perinatol 2021; 38(08): 759-765
DOI: 10.1055/s-0040-1721698
SMFM Fellowship Series Article

Interpregnancy Body Mass Index Change and Risk of Intrapartum Cesarean Delivery

Tetsuya Kawakita 
1   Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
2   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Stephanie Franco
3   Georgetown University School of Medicine, Washington, District of Columbia
,
Atoosa Ghofranian
4   Department of Obstetrics and Gynecology, Northwell Health, Manhattan, New York
,
Alexandra Thomas
3   Georgetown University School of Medicine, Washington, District of Columbia
,
Helain J. Landy
5   Department of Obstetrics and Gynecology, MedStar Georgetown University Hospital, Washington, District of Columbia
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Objective This study aimed to examine the association between interpregnancy body mass index (BMI, kg/m2) change and intrapartum cesarean delivery in multiparous women without a history of cesarean delivery.

Study Design We conducted a retrospective cohort study of all women who had more than one singleton pregnancy at 23 weeks' gestation or greater at MedStar Washington Hospital Center from January 2009 to June 2018. We excluded women who had a history of cesarean delivery, prelabor cesarean delivery, and contraindications for vaginal delivery. Interpregnancy BMI change was calculated by the change of early pregnancy BMI measured in the office. Women were categorized according to the interpregnancy BMI change (BMI loss more than 2 kg/m2, BMI change ± 2 kg/m2, and BMI gain more than 2 kg/m2). The primary outcome was an intrapartum cesarean delivery. Multivariable logistic regression was performed to calculate adjusted odds ratio (aOR) with 95% confidence interval (CI) after adjusting for predefined covariates.

Results Of 2,168 women who were analyzed, 258 (12%), 1,192 (55%), and 718 (33%) had interpregnancy BMI loss more than 2 kg/m2, BMI change ± 2 kg/m2, and BMI gain more than 2 kg/m2, respectively. Women with BMI gain more than 2 kg/m2 compared with those with BMI change ± 2 kg/m2 had increased odds of intrapartum cesarean delivery (7.4 vs. 4.5%; aOR: 1.78; 95% CI: 1.10–2.86) and cesarean delivery for arrest disorders (3.1 vs. 1.1%; aOR: 3.06; 95% CI: 1.30–7.15). Women with BMI loss more than 2 kg/m2 compared with those with BMI change ± 2 kg/m2 had similar rates of cesarean delivery.

Conclusion Compared with interpregnancy BMI change ± 2 kg/m2, interpregnancy BMI gain 2 kg/m2 was associated with increased odds of intrapartum cesarean delivery.

Key Points

  • BMI gain between pregnancies was associated with intrapartum cesarean delivery.

  • BMI loss between pregnancies was not associated with intrapartum cesarean delivery.

  • Our study suggests that at least maintaining weight between pregnancies is beneficial.

Keywords

arrest - obesity - weight gain

Note

This article was presented as a poster presentation at the SMFM's 40th Annual Meeting, The Pregnancy Meeting, Grapevine, TX (February 3–8, 2020).




Publication History

Received: 09 June 2020

Accepted: 04 November 2020

Article published online:
25 December 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2016. Natl Vital Stat Rep 2018; 67 (01) 1-55
    Google Scholar
  • 2 Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, Bréart G. Postpartum maternal mortality and cesarean delivery. Obstet Gynecol 2006; 108 (3 Pt 1): 541-548
    CrossrefPubMedGoogle Scholar
  • 3 MacDorman MF, Declercq E, Menacker F, Malloy MH. Neonatal mortality for primary cesarean and vaginal births to low-risk women: application of an “intention-to-treat” model. Birth 2008; 35 (01) 3-8
    CrossrefPubMedGoogle Scholar
  • 4 Curtin SC, Gregory KD, Korst LM, Uddin SF. Maternal morbidity for vaginal and cesarean deliveries, according to previous cesarean history: new data from the birth certificate, 2013. Natl Vital Stat Rep 2015; 64 (04) 1-13 , back cover
    Google Scholar
  • 5 Silver RM, Landon MB, Rouse DJ. et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107 (06) 1226-1232
    CrossrefPubMedGoogle Scholar
  • 6 Hu HT, Xu JJ, Lin J. et al. Association between first caesarean delivery and adverse outcomes in subsequent pregnancy: a retrospective cohort study. BMC Pregnancy Childbirth 2018; 18 (01) 273
    CrossrefPubMedGoogle Scholar
  • 7 Smith GC, Pell JP, Dobbie R. Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet 2003; 362 (9398): 1779-1784
    CrossrefPubMedGoogle Scholar
  • 8 American College of Obstetricians and Gynecologists; Society for maternal-Fetal Medicine.. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol 2014; 123 (03) 693-711
    CrossrefPubMedGoogle Scholar
  • 9 Centers for Disease Control and Prevention. Health, United States, 2018: National Center for Health Statistics. Retrieved December 4, 2019 at: https://www.cdc.gov/nchs/hus/contents2018.htm?search=Obesity/overweight
    Google Scholar
  • 10 Endres LK, Straub H, McKinney C. et al; Community Child Health Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Postpartum weight retention risk factors and relationship to obesity at 1 year. Obstet Gynecol 2015; 125 (01) 144-152
    CrossrefPubMedGoogle Scholar
  • 11 Kawakita T, Reddy UM, Landy HJ, Iqbal SN, Huang CC, Grantz KL. Indications for primary cesarean delivery relative to body mass index. Am J Obstet Gynecol 2016; 215 (04) 515.e1-515.e9
    CrossrefPubMedGoogle Scholar
  • 12 Kominiarek MA, Vanveldhuisen P, Hibbard J. et al; Consortium on Safe Labor. The maternal body mass index: a strong association with delivery route. Am J Obstet Gynecol 2010; 203 (03) 264.e1-264.e7
    CrossrefPubMedGoogle Scholar
  • 13 Hermann M, Le Ray C, Blondel B, Goffinet F, Zeitlin J. The risk of prelabor and intrapartum cesarean delivery among overweight and obese women: possible preventive actions. Am J Obstet Gynecol 2015; 212 (02) 241.e1-241.e9
    CrossrefPubMedGoogle Scholar
  • 14 Dude AM, Lane-Cordova AD, Grobman WA. Interdelivery weight gain and risk of cesarean delivery following a prior vaginal delivery. Am J Obstet Gynecol 2017; 217 (03) 373.e1-373.e6
    CrossrefPubMedGoogle Scholar
  • 15 Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet 2006; 368 (9542): 1164-1170
    CrossrefPubMedGoogle Scholar
  • 16 Cnattingius S, Villamor E. Weight change between successive pregnancies and risks of stillbirth and infant mortality: a nationwide cohort study. Lancet 2016; 387 (10018): 558-565
    CrossrefPubMedGoogle Scholar
  • 17 Jain AP, Gavard JA, Rice JJ, Catanzaro RB, Artal R, Hopkins SA. The impact of interpregnancy weight change on birthweight in obese women. Am J Obstet Gynecol 2013; 208 (03) 205.e1-205.e7
    CrossrefPubMedGoogle Scholar
  • 18 Fryar CD, Kruszon-Moran D, Gu Q, Ogden CL. Mean body weight, height, waist circumference, and body mass index among adults: United States, 1999–2000 through 2015–2016. Natl Health Stat Report 2018; (122) 1-16
    PubMedGoogle Scholar
  • 19 Stotland NE, Hopkins LM, Caughey AB. Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas. Obstet Gynecol 2004; 104 (04) 671-677
    CrossrefPubMedGoogle Scholar
  • 20 Stuebe AM, Kleinman K, Gillman MW, Rifas-Shiman SL, Gunderson EP, Rich-Edwards J. Duration of lactation and maternal metabolism at 3 years postpartum. J Womens Health (Larchmt) 2010; 19 (05) 941-950
    CrossrefPubMedGoogle Scholar
  • 21 Amorim Adegboye AR, Linne YM. Diet or exercise, or both, for weight reduction in women after childbirth. Cochrane Database Syst Rev 2013; (07) CD005627
    PubMedGoogle Scholar