Abstract
Abstract only
Background:
The prevalence of obesity among people of reproductive age has steadily increased. The rates of both maternal/parental and fetal adverse outcomes increased significantly with higher BMI. In this study, we examined the national estimates of adverse maternal/parental and fetal outcomes among pregnant individuals with pre-pregnancy obesity using a nationally representative database.
Methods:
This was a retrospective observational analysis of data retrieved from the Nationwide Inpatient Sample database (2010-2014). The primary outcomes of this study were various adverse maternal/parental and fetal outcomes. Delivery related hospitalizations and all outcomes were identified using the ICD-9 codes. Additionally, propensity-score matching analysis was conducted.
Results:
There were a total of 18,687,217 delivery-related hospitalizations, of which 1,048,323 were among people with obesity. The mean age of pregnant persons with obesity was 28.5 years while among those without obesity was 28.0 years. Between both groups, most pregnant persons were White, followed by Hispanic and Black. Pregnant persons with obesity were more likely to have labor inductions (AOR: 1.51; 95% CI: 1.42, 1.60), cesarean deliveries (1.70; 1.62, 1.79), and greater length of stay after both cesarean deliveries (1.14; 1.08, 1.36) and vaginal deliveries (1.48; 1.23, 1.77). They were also more likely to have risk factors for adverse obstetrical outcomes such as gestational hypertension (2.17; 2.06, 2.29), preeclampsia (2.06; 1.42, 2.99), gestational diabetes (2.75; 2.60, 2.90), premature rupture of membranes (1.17; 1.08, 1.27), chorioamnionitis (1.39; 1.25, 1.55), and venous thromboembolism (1.63; 1.34, 1.99). Additionally, pregnant persons with obesity were more likely to have adverse fetal outcomes such as excessive fetal growth (3.18; 2.96, 3.43) and fetal distress (1.28; 1.21, 1.35).
Conclusion:
Pregnant persons with obesity had significantly greater risk for adverse obstetrical outcomes. Risk stratification of pregnant individuals based on obesity can inform obstetrical providers’ clinical decision-making and potentially improve patient outcomes and decrease costs. There is an opportunity to address these risks with pre-conception interventions. Future studies could examine the effect of pre-conception interventions such as counseling on pre-pregnancy weight management, lifestyle modifications addressing nutrition and activity, and pre-pregnancy bariatric surgery.
