Download PDF
Am J Perinatol 2016; 33(12): 1198-1204
DOI: 10.1055/s-0036-1586122
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Maternal Super Obesity and Neonatal Morbidity after Term Cesarean Delivery

Marcela C. Smid
1   Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Catherine J. Vladutiu
1   Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Sarah K. Dotters-Katz
1   Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Tracy A. Manuck
1   Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
Kim A. Boggess
1   Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina
,
David M. Stamilio
1   Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina
› Author Affiliations
Further Information

Publication History

10 June 2016

13 June 2016

Publication Date:
27 July 2016 (online)

    Permissions and Reprints

Abstract

Objective To estimate the association between maternal super obesity (body mass index [BMI] ≥ 50 kg/m2) and neonatal morbidity among neonates born via cesarean delivery (CD).

Methods Retrospective cohort of singleton neonates delivered via CD ≥ 37 weeks in the Maternal-Fetal Medicine Unit Cesarean Registry. Maternal BMI at delivery was stratified as 18.5 to 29.9 kg/m2, 30 to 39.9 kg/m2, 40 to 49.9 kg/m2, and ≥ 50 kg/m2. Primary outcomes included acute (5-minute Apgar score < 5, cardiopulmonary resuscitation and ventilator support < 24 hours, neonatal injury, and/or transient tachypnea of the newborn) and severe (grade 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, seizure, respiratory distress syndrome, hypoxic ischemic encephalopathy, meconium aspiration, ventilator support ≥ 2 days, sepsis and/or neonatal death) neonatal morbidity. Odds of neonatal morbidity were estimated for each BMI category adjusting for clinical and operative characteristics.

Results Of 41,262 maternal–neonatal dyads, 36% of women were nonobese, 49% had BMI of 30 to 39.9 kg/m2, 12% had BMI of 40 to 49.9 kg/m2, and 3% were super obese. Compared with nonobese women, super obese women had twofold odds of acute (5 vs. 10%; adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.59–2.73) and severe (3 vs. 6%; aOR: 2.08; 95% CI: 1.59–2.73) neonatal morbidity.

Conclusion Among term infants delivered via CD, maternal super obesity is associated with increased risk of neonatal morbidity.

Keywords

cesarean delivery - neonatal morbidity - obesity - super obesity

Note

This paper was presented at the 2016 Society for Maternal-Fetal Medicine's Annual Meeting in Atlanta, GA, as two poster presentations (final abstract IDs: 221 and 650).


 

  • References

  • 1 Sturm R. Increases in clinically severe obesity in the United States, 1986-2000. Arch Intern Med 2003; 163 (18) 2146-2148
    CrossrefPubMedGoogle Scholar
  • 2 Stotland NE, Hopkins LM, Caughey AB. Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas. Obstet Gynecol 2004; 104 (4) 671-677
    CrossrefPubMedGoogle Scholar
  • 3 Crane JM, Murphy P, Burrage L, Hutchens D. Maternal and perinatal outcomes of extreme obesity in pregnancy. J Obstet Gynaecol Can 2013; 35 (7) 606-611
    CrossrefPubMedGoogle Scholar
  • 4 Chu SY, Kim SY, Schmid CH , et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obes Rev 2007; 8 (5) 385-394
    CrossrefPubMedGoogle Scholar
  • 5 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 (3) 264.e1-264.e7
    CrossrefPubMedGoogle Scholar
  • 6 Kominiarek MA, VanVeldhuisen P, Hibbard J , et al. The maternal body mass index: a strong association with delivery route. Am J Obstet Gynecol 2010; 203: 264.e1-e7
    CrossrefPubMedGoogle Scholar
  • 7 Marshall NE, Guild C, Cheng YW, Caughey AB, Halloran DR. Maternal superobesity and perinatal outcomes. Am J Obstet Gynecol 2012; 206 (5) 417.e1-417.e6
    CrossrefPubMedGoogle Scholar
  • 8 Alanis MC, Goodnight WH, Hill EG, Robinson CJ, Villers MS, Johnson DD. Maternal super-obesity (body mass index > or = 50) and adverse pregnancy outcomes. Acta Obstet 2010; 89 (7) 924-930
    PubMedGoogle Scholar
  • 9 Brocato BE, Thorpe Jr EM, Gomez LM, Wan JY, Mari G. The effect of cesarean delivery skin incision approach in morbidly obese women on the rate of classical hysterotomy. J Pregnancy 2013; 2013: 890296
    PubMedGoogle Scholar
  • 10 Smid MC, Kearney MS, Stamilio DM. Extreme obesity and postcesarean wound complications in the Maternal-Fetal Medicine Unit Cesarean Registry. Am J Perinatol 2015; 32 (14) 1336-1341
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Stamilio DM, Scifres CM. Extreme obesity and postcesarean maternal complications. Obstet Gynecol 2014; 124 (2 Pt 1): 227-232
    CrossrefPubMedGoogle Scholar
  • 12 Robinson HE, O'Connell CM, Joseph KS, McLeod NL. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol 2005; 106 (6) 1357-1364
    CrossrefPubMedGoogle Scholar
  • 13 El-Sayed YY, Watkins MM, Fix M, Druzin ML, Pullen KM, Caughey AB. Perinatal outcomes after successful and failed trials of labor after cesarean delivery. Am J Obstet Gynecol 2007; 196 (6) 583.e1-583.e5 , discussion 583.e5
    CrossrefPubMedGoogle Scholar
  • 14 Kolås T, Saugstad OD, Daltveit AK, Nilsen ST, Øian P. Planned cesarean versus planned vaginal delivery at term: comparison of newborn infant outcomes. Am J Obstet Gynecol 2006; 195 (6) 1538-1543
    CrossrefPubMedGoogle Scholar
  • 15 Landon MB. Predicting uterine rupture in women undergoing trial of labor after prior cesarean delivery. Semin Perinatol 2010; 34 (4) 267-271
    CrossrefPubMedGoogle Scholar
  • 16 Gerten KA, Coonrod DV, Bay RC, Chambliss LR. Cesarean delivery and respiratory distress syndrome: does labor make a difference?. Am J Obstet Gynecol 2005; 193 (3 Pt 2): 1061-1064
    CrossrefPubMedGoogle Scholar
  • 17 Girsen AI, Osmundson SS, Naqvi M, Garabedian MJ, Lyell DJ. Body mass index and operative times at cesarean delivery. Obstet Gynecol 2014; 124 (4) 684-689
    CrossrefPubMedGoogle Scholar
  • 18 Datta S, Ostheimer GW, Weiss JB, Brown Jr WU, Alper MH. Neonatal effect of prolonged anesthetic induction for cesarean section. Obstet Gynecol 1981; 58 (3) 331-335
    PubMedGoogle Scholar
  • 19 Persson M, Johansson S, Villamor E, Cnattingius S. Maternal overweight and obesity and risks of severe birth-asphyxia-related complications in term infants: a population-based cohort study in Sweden. PLoS Med 2014; 11 (5) e1001648
    CrossrefPubMedGoogle Scholar
  • 20 Bonnesen B, Secher NJ, Møller LK, Rasmussen S, Andreasen KR, Renault K. Pregnancy outcomes in a cohort of women with a preconception body mass index >50 kg/m². Acta Obstet Gynecol Scand 2013; 92 (9) 1111-1114
    CrossrefPubMedGoogle Scholar
  • 21 Blomberg M. Maternal obesity, mode of delivery, and neonatal outcome. Obstet Gynecol 2013; 122 (1) 50-55
    CrossrefPubMedGoogle Scholar
  • 22 Conner SN, Tuuli MG, Longman RE, Odibo AO, Macones GA, Cahill AG. Impact of obesity on incision-to-delivery interval and neonatal outcomes at cesarean delivery. Am J Obstet Gynecol 2013; 209 (4) 386.e1-386.e6
    CrossrefPubMedGoogle Scholar
  • 23 Edwards RK, Cantu J, Cliver S, Biggio Jr JR, Owen J, Tita AT. The association of maternal obesity with fetal pH and base deficit at cesarean delivery. Obstet Gynecol 2013; 122 (2 Pt 1): 262-267
    CrossrefPubMedGoogle Scholar
  • 24 Sutton AL, Sanders LB, Subramaniam A, Jauk VC, Edwards RK. Abdominal incision selection for cesarean delivery of women with class III obesity. Am J Perinatol 2016; 33 (6) 547-551
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol 2010; 203 (3) 271.e1-271.e7
    CrossrefPubMedGoogle Scholar
  • 26 Himmelmann K, Ahlin K, Jacobsson B, Cans C, Thorsen P. Risk factors for cerebral palsy in children born at term. Acta Obstet Gynecol Scand 2011; 90 (10) 1070-1081
    CrossrefPubMedGoogle Scholar
  • 27 Lie KK, Grøholt E-K, Eskild A. Association of cerebral palsy with Apgar score in low and normal birthweight infants: population based cohort study. BMJ 2010; 341: c4990
    CrossrefPubMedGoogle Scholar
  • 28 Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012; 307 (5) 491-497
    CrossrefPubMedGoogle Scholar
  • 29 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014; 311 (8) 806-814
    CrossrefPubMedGoogle Scholar
  • 30 Smid MC, Smiley SG, Schulkin J , et al. The problem of the pannus: physician preference survey and a review of the literature on cesarean skin incision in morbidly obese women. Am J Perinatol 2016; 33 (5) 463-472
    Article in Thieme ConnectPubMedGoogle Scholar