Obesity in Pregnancy and Mode of Delivery Open Access

Abstract

OBJECTIVE: To estimate the effect of obesity on risk of cesarean delivery among pregnant women.

METHODS: Data were collected retrospectively from an electronic database that records antepartum and intrapartum medical information. Deliveries between January 2005 and January 2010 were used for analysis. Body mass index (BMI) was used as a measure of weight classification. Obese (BMI ≥30) pregnant women were compared to normal weight (BMI 20 to 24.9) pregnant women. Odds ratios for risk of cesarean delivery among both groups of pregnant women were estimated using multivariate logistic regression, adjusting for confounding variables.

RESULTS: Compared to women with a normal BMI, cesarean delivery is twice as likely as vaginal delivery in women with a BMI ≥ 30 (OR = 2.03, 95% C.I. 1.38 - 2.98, p=0.0003). Adjusting for maternal age, obese women remain at increased risk for cesarean section (OR = 1.91, 95% C.I. 1.30 - 2.82, p=0.001). Using multiple logistic regression analysis and controlling for maternal age, infant birth weight, Apgar score at 1 and 5 minutes, gestational age at time of delivery, and infant gender simultaneously, obese women are 1.83 times as likely as normal weight women to have a cesarean delivery (95% C.I. 1.19 - 2.79, p=0.006). We also show that as BMI increases, the risk of cesarean section increases in a dose response manner ( p=0.001). Other factors associated with increased risk of cesarean delivery include maternal age ≥35 years (OR = 1.67, 95% C.I. 1.13 - 2.53, p=0.01) and neonatal Apgar score at 1 minute of life of 6 or less (OR = 2.01, 95% C.I. 1.15 - 3.52, p=0.01). Women who delivered female infants are less likely to undergo a cesarean section (OR = 0.67, 95% C.I. 0.48 - 0.95, p=0.03).

CONCLUSION: Obesity remains a significant risk factor for cesarean delivery. This risk increases as BMI increases.

Table of Contents

Table of Contents

Introduction............................. 1

Methods................................2-3

Results................................. 3-8

Discussion............................ 8-13

References..........................14-16

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Obstetrics and Gynecology Health Sciences, Medicine and Surgery Health Sciences, Public Health
Keyword	cesarean pregnancy obesity
Committee Chair / Thesis Advisor	Hogue, Carol J, Emory University
Partnering Agencies	Hospital or other health care provider

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