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Am J Perinatol 2024; 41(06): 669-676
DOI: 10.1055/s-0043-1776975
SMFM Fellowship Series Article

The Relationship between Gestational Weight Gain and Cesarean Delivery among Patients undergoing Induction of Labor

Authors

  • Whitney R. Bender 

    1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
    2   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia

  • Rebecca F. Hamm 

    1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

  • Cara Dolin

    1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

  • Lisa D. Levine 

    1   Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

Funding None.
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Abstract

Objective This study aimed to determine the impact of pregnancy weight gain above National Academy of Medicine (NAM) guidelines on cesarean delivery rates following induction.

Study Design This is a secondary analysis of a prospective cohort study of patients who underwent induction at a single tertiary care center between July 2017 and July 2019. Included in the primary study were patients undergoing term (≥37 weeks) labor induction with a singleton gestation, intact membranes, and unfavorable cervical examination (Bishop score of ≤6 and cervical dilation ≤ 2 cm). Eligibility for this analysis was limited to patients with a documented prenatal body mass index (BMI) < 20 weeks' gestation. The primary exposure was gestational weight gain greater than NAM guidelines (WGGG) for a patient's initial BMI category. The primary outcome was cesarean delivery for any indication.

Results Of 1,610 patients included in the original cohort, 1,174 (72.9%) met inclusion criteria for this analysis and 517 (44.0%) of these had weight gain above NAM guidelines. Of the entire cohort, 60.0% were Black and 52.7% had private insurance. In total, 160 patients (31%) with WGGG underwent cesarean compared with 127 patients (19.3%) without WGGG (p < 0.001), which equates to a 59% increased odds of cesarean when controlling for initial BMI category, parity, gestational diabetes, and indication for induction (Adjusted Odds Ratio [aOR] 1.58, 95% confidence interval [CI] 1.17–2.12). Among only nulliparous patients, WGGG was associated with an increased odds of cesarean (26.4 vs. 38.2%, aOR 1.50, 95% CI 1.07–2.10). In multiparous patients, however, there was no difference in cesarean between those with and without WGGG (8.8 vs. 14.1%, aOR 1.85, 95% CI 0.96–3.58).

Conclusion This study demonstrates that weight gain above NAM guidelines is associated with more than a 50% increased odds of cesarean. Patients should be informed of this association as gestational weight gain may be a modifiable risk factor for cesarean delivery.

Key Points

  • Weight gain above NAM guidelines was associated with a 59% increased odds of cesarean delivery.

  • Nulliparous patients with weight gain above NAM guidelines are at higher risk of cesarean delivery.

  • No difference in cesarean delivery among multiparous patients regardless of gestational weight gain.

Keywords

cesarean delivery - gestational weight gain - induction of labor - labor - pregnancy - prenatal care


Publication History

Received: 24 August 2021

Accepted: 22 October 2023

Article published online:
16 November 2023

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