Advertisement

The risk of prelabor and intrapartum cesarean delivery among overweight and obese women: possible preventive actions

  • Monika Hermann
    Correspondence
    Corresponding author: Monika Hermann, MD.
    Affiliations
    INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris V, René Descartes University, Paris, France

    Department of Obstetrics and Gynecology, Port-Royal Maternity, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
    Search for articles by this author
  • Camille Le Ray
    Affiliations
    INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris V, René Descartes University, Paris, France

    Department of Obstetrics and Gynecology, Port-Royal Maternity, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
    Search for articles by this author
  • Béatrice Blondel
    Affiliations
    INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris V, René Descartes University, Paris, France
    Search for articles by this author
  • François Goffinet
    Affiliations
    INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris V, René Descartes University, Paris, France

    Department of Obstetrics and Gynecology, Port-Royal Maternity, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France
    Search for articles by this author
  • Jennifer Zeitlin
    Affiliations
    INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris V, René Descartes University, Paris, France
    Search for articles by this author
Published:August 06, 2014DOI:https://doi.org/10.1016/j.ajog.2014.08.002

      Objective

      The purpose of this study was to investigate prelabor and intrapartum cesarean delivery in overweight and obese women by parity, previous cesarean delivery, and labor induction to assess what preventive actions might be possible.

      Study Design

      We modeled relative risks (RRs) and risk differences of prelabor and intrapartum cesarean delivery by prepregnancy body mass index (obese, ≥30 kg/m2; overweight, 25-29.9 kg/m2; normal weight, 18.5-24.9 kg/m2) in a nationally representative sample of 12,297 French women. Models were stratified by parity and previous cesarean status. Covariates included maternal sociodemographic characteristics, medical conditions, pregnancy complications, and induction of labor.

      Results

      Risks of prelabor cesarean delivery were elevated only for obese multiparous women. This reflected not only a higher prevalence of previous cesarean delivery (26.4% vs 17.9% for normal-weight women) but also higher risks of prelabor cesarean delivery for multiparous women with no previous cesarean delivery after adjustment for medico-obstetric factors (RR, 1.82; 95% confidence interval [CI], 1.25–2.64). Obese primiparous women and multiparous women with no previous cesarean delivery had similarly increased adjusted RRs for intrapartum cesarean delivery (RR, 1.64; 95% CI, 1.36–1.98; and RR, 1.66; 95% CI, 1.15–2.39, respectively), but the risk difference was higher for primiparous women, with an absolute increase of 0.10 (95% CI, 0.05–0.14) compared with 0.02 (95% CI, 0.00–0.04) for multiparous women. Increased intrapartum cesarean delivery risks for primiparous women were related to more frequent labor induction (42.6% vs 23.8% for normal-weight women).

      Conclusion

      It may be possible to reduce primary and thus repeat cesarean delivery rates among obese women by preventive actions targeting labor induction in primiparous women and prelabor cesarean deliveries in multiparous women. Further research is needed on the impact of limiting inductions on cesarean delivery risks for obese primiparous women.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American College of Obstetricians and Gynecologists
        Obesity in pregnancy. ACOG Committee opinion, no. 549.
        Obstet Gynecol. 2012; 121: 213-217
        • Chu S.Y.
        • Kim S.Y.
        • Schmid C.H.
        • et al.
        Maternal obesity and risk of cesarean delivery: a meta-analysis.
        Obes Rev. 2007; 8: 385-394
        • Schneid-Kofman N.
        • Sheiner E.
        • Levy A.
        • Holcberg G.
        Risk factors for wound infection following cesarean deliveries.
        Int J Obstet Gynaecol. 2005; 90: 10-15
        • Ibrahim M.I.
        • Moustafa G.F.
        • Al-Hamid A.S.
        • Hussein M.R.
        Superficial incisional surgical site infection rate after cesarean section in obese women: a randomized controlled trial of subcuticular versus interrupted skin suturing.
        Arch Gynecol Obstet. 2014; 289: 981-986
        • Robinson H.E.
        • O’Connell C.M.
        • Joseph K.S.
        • McLeod N.L.
        Maternal outcomes in pregnancies complicated by obesity.
        Obstet Gynecol. 2005; 106: 1357-1364
        • Heyl P.S.
        • Sappenfield W.M.
        • Burch D.
        • Hernandez L.E.
        • Kavanaugh V.M.
        • Hill W.C.
        Pregnancy-related deaths due to pulmonary embolism: findings from two state-based mortality reviews.
        Matern Child Health J. 2013; 17: 1230-1235
        • Miller E.S.
        • Hahn K.
        • Grobman W.A.
        Consequences of a primary elective cesarean delivery across the reproductive life.
        Obstet Gynecol. 2013; 121: 789-797
        • Chu S.Y.
        • Kim S.Y.
        • Lau J.
        • et al.
        Maternal obesity and risk of stillbirth: a metaanalysis.
        Am J Obstet Gynecol. 2007; 197: 223-228
        • Sebire N.J.
        • Jolly M.
        • Harris J.P.
        • et al.
        Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London.
        Int J Obes Relat Metab Disord. 2001; 25: 1175-1182
        • Weiss J.L.
        • Malone F.D.
        • Emig D.
        • et al.
        Obesity, obstetric complications and cesarean delivery rate: a population-based screening study.
        Am J Obstet Gynecol. 2004; 190: 1091-1097
        • Poobalan A.S.
        • Aucott L.S.
        • Gurung T.
        • Smith W.C.
        • Bhattacharya S.
        Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women: systematic review and meta-analysis of cohort studies.
        Obes Rev. 2009; 10: 28-35
        • Roman H.
        • Goffinet F.
        • Hulsey T.F.
        • Newman R.
        • Robillard P.Y.
        • Hulsey T.C.
        Maternal body mass index at delivery and risk of caesarean due to dystocia in low risk pregnancies.
        Acta Obstet Gynecol Scand. 2008; 87: 163-170
        • Nuthalapaty F.S.
        • Rouse D.J.
        • Owen J.
        The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction.
        Obstet Gynecol. 2004; 103: 452-456
        • Wuntakal R.
        • Kaler M.
        • Hollingworth T.
        Women with high BMI: should they be managed differently due to antagonising action of leptin in labour?.
        Med Hypotheses. 2013; 80: 767-768
        • Cedergren M.I.
        Non-elective caesarean delivery due to ineffective uterine contractility or due to obstructed labour in relation to maternal body mass index.
        Eur J Obstet Gynecol Reprod Biol. 2009; 145: 163-166
        • Zhang J.
        • Bricker L.
        • Wray S.
        • Quenby S.
        Poor uterine contractility in obese women.
        BJOG. 2007; 114: 343-348
        • Bergholt T.
        • Lim K.L.
        • Jorgensen J.S.
        • Robson M.S.
        Maternal body mass index in the first trimester and risk of cesarean delivery in nulliparous women in spontaneous labor.
        Am J Obstet Gynecol. 2007; 196: 163.e1-163.e5
        • Cnattingius R.
        • Hoglund B.
        • Kieler H.
        Emergency cesarean delivery in induction of labor: an evaluation of risk factors.
        Acta Obstet Gynecol Scand. 2005; 84: 456-462
        • Landon M.B.
        • Leindecker S.
        • Spong C.Y.
        • et al.
        The MFMU Cesarean Registry: factors affecting the success of trial of labor after previous cesarean delivery.
        Am J Obstet Gynecol. 2005; 193: 1016-1023
        • Zhang J.
        • Troendle J.
        • Reddy U.M.
        • et al.
        Contemporary cesarean delivery practice in the United States.
        Am J Obstet Gynecol. 2010; 203: 326.e1-326.e10
        • Sherrard A.
        • Platt R.W.
        • Vallerand D.
        • Usher R.H.
        • Zhang X.
        • Kramer M.S.
        Maternal anthropometric risk factors for caesarean delivery before or after onset of labour.
        BJOG. 2007; 114: 1088-1096
        • Blondel B.
        • Lelong N.
        • Kermarrec M.
        • Goffinet F.
        Trends in perinatal health in France from 1995 to 2010. Results from the French National Perinatal Surveys.
        J Gynecol Obstet Biol Reprod (Paris). 2012; 41: e1-e15
        • Han Z.
        • Mulla S.
        • Beyene J.
        • Liao G.
        • McDonald S.D.
        Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses.
        Int J Epidemiol. 2010; 40: 65-101
      1. World Healths Organization. WHO Global Database on Body Mass Index. Available at: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed April 23, 2014.

        • Wispelwey B.P.
        • Sheiner E.
        Cesarean delivery in obese women: a comprehensive review.
        J Matern Fetal Neonatal Med. 2013; 26: 547-551
        • Mamelle N.
        • Munoz F.
        • Grandjean H.
        [Fetal growth from the AUDIPOG study: I, establishment of reference curves].
        J Gynecol Obstet Biol Reprod (Paris). 1996; 25: 61-70
        • Backe B.
        • Nakling J.
        Effectiveness of antenatal care: a population based study.
        BJOG. 1993; 100: 727-732
        • Figueras F.
        • Gardosi J.
        Intrauterine growth restriction: new concepts in antenatal surveillance, diagnosis, and management.
        Am J Obstet Gynecol. 2011; 204: 288-300
        • Hepburn M.
        • Rosenberg K.
        An audit of the detection and management of small-for-gestational age babies.
        BJOG. 1986; 93: 212-216
        • Zou G.
        A modified poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. 2004; 159: 702-706
        • Caughey A.B.
        Preventive induction of labor: can its use lower the cesarean delivery rate?.
        J Womens Health (Larchmt). 2009; 18: 1743-1745
        • Stotland N.E.
        • Hopkins L.M.
        • Caughey A.B.
        Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas.
        Obstet Gynecol. 2004; 104: 671-677
        • Hibbard J.U.
        • Gilbert S.
        • Landon M.B.
        • et al.
        Trial of labor or repeat cesarean delivery in women with morbid obesity and previous cesarean delivery.
        Obstet Gynecol. 2006; 108: 125-133
        • Sentilhes L.
        • Vayssiere C.
        • Beucher G.
        • et al.
        Delivery for women with a previous cesarean: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF).
        Eur J Obstet Gynecol Reprod Biol. 2013; 1: 25-32
        • Kaiser P.S.
        • Kirby R.S.
        Obesity as a risk factor for cesarean in a low-risk population.
        Obstet Gynecol. 2001; 97: 39-43
        • Crane S.S.
        • Wojtowycz M.A.
        • Dye T.D.
        • Aubry R.H.
        • Artal R.
        Association between pre-pregnancy obesity and the risk of cesarean delivery.
        Obstet Gynecol. 1997; 89: 213-216
        • Arrowsmith S.
        • Wray S.
        • Quenby S.
        Maternal obesity and labour complications following induction of labour in prolonged pregnancy.
        BJOG. 2011; 118: 578-588
        • Coulm B.
        • Blondel B.
        • Alexander S.
        • et al.
        Potential avoidability of planned cesarean sections in a French national database.
        Acta Obstet Gynecol Scand. 2014; ([Epub ahead of print])
        • Beucher G.
        • Dreyfus M.
        Management of postterm pregnancies.
        J Gynecol Obstet Biol Reprod. 2008; 37: 107-117
        • Wolfe H.
        • Timofeev J.
        • Tefera E.
        • Desale S.
        • Driggers R.W.
        Risk of cesarean in obese nulliparous women with unfavorable cervix: elective induction vs expectant management at term.
        Am J Obstet Gynecol. 2014; 211: 53-55
        • Darney B.G.
        • Snowden J.M.
        • Cheng Y.W.
        • et al.
        Elective induction of labor at term compared with expectant management: maternal and neonatal outcomes.
        Obstet Gynecol. 2013; 122: 761-769
        • Stock S.J.
        • Ferguson E.
        • Duffy A.
        • Ford I.
        • Chalmers J.
        • Norman J.E.
        Outcomes of elective induction of labour compared with expectant management: population based study.
        BMJ. 2012; 344: e2838
        • Branch D.W.
        • Silver R.M.
        Managing the primary cesarean delivery rate.
        Clin Obstet Gynecol. 2012; 55: 946-960
        • Huesch M.D.
        • Currid-Halkett E.
        • Doctor J.N.
        Measurement and risk adjustment of prelabor cesarean rates in a large sample of California hospitals.
        Am J Obstet Gynecol. 2014; 210: 443-517
        • Galtier-Dereure F.
        • Boegner C.
        • Bringer J.
        Obesity and pregnancy: complications and cost.
        Am J Clin Nutr. 2000; 71: 1242S-1248S
        • Trasande L.
        • Lee M.
        • Liu Y.
        • Weitzman M.
        • Savitz D.
        Incremental charges, costs, and length of stay associated with obesity as a secondary diagnosis among pregnant women.
        Med Care. 2009; 47: 1046-1052
        • Quantin C.
        • Cottenet J.
        • Vuagnat A.
        • et al.
        [Quality of perinatal statistics from hospital discharge data: Comparison with civil registration and the 2010 National Perinatal Survey.].
        J Gynecol Obstet Biol Reprod (Paris). 2013; ([Epub ahead of print])
        • Tixier H.
        • Thouvenot S.
        • Coulange L.
        • et al.
        Cesarean section in morbidly obese women: supra or subumbilical transverse incision?.
        Acta Obstet Gynecol Scand. 2009; 88: 1049-1052
        • Yoong S.L.
        • Carey M.L.
        • D’Este C.
        • Sanson-Fisher R.W.
        Agreement between self-reported and measured weight and height collected in general practice patients: a prospective study.
        BMC Med Res Methodol. 2013; 13: 38
        • Yu S.M.
        • Nagey D.A.
        Validity of self-reported pregravid weight.
        Ann Epidemiol. 1992; 2: 715-721