Angeliki Antonakou, Dimitrios Papoutsis, Chara Tzavara
Department of Midwifery, Midwifery School, 'Alexander' Technological Educational Institute of Thessaloniki, Greece.
Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom.
Eur J Midwifery. 2018 Apr 12;2:4. doi: 10.18332/ejm/85792. eCollection 2020.
Maternal obesity carries an increased risk of complications during pregnancy and childbirth. This study investigated whether the body mass index (BMI) of women with induced labour was associated with the mode of delivery and neonatal outcome.
This was a retrospective study of primigravidae women under the age of 40 years who were induced at term for various indications. Data were collected from the electronic database of the Maternity Unit where these women gave birth.
We sampled 1274 women with a mean age of 26.3±5.9 years. The mean BMI at booking was 26.5 kg/m, with 28.8% being overweight and 24.3% obese. In the sample, 70.4% had a normal vaginal delivery, 15.4% a caesarean section (CS) and 14.2% an instrumental delivery. An increasing BMI was independently associated with the odds for a CS, with women who were overweight and obese having a 1.58 and 2.75 times greater likelihood for a CS. The CS rate was 10.2% in women with a normal BMI, and increased to 15.8% for overweight and 24.9% for obese women (p<0.001). The increasing BMI did not affect the instrumental delivery rates in our cohort. The Apgar scores at one and five minutes were significantly lower in overweight and obese women compared to women with a normal BMI.
We show that an increasing BMI in women with induced labour was associated with increased CS rates and lower Apgar scores. These findings highlight the important role of midwives in engaging women in weight management before they get pregnant.
孕产妇肥胖会增加妊娠和分娩期间并发症的风险。本研究调查了引产妇女的体重指数（BMI）是否与分娩方式及新生儿结局相关。
这是一项对40岁以下因各种指征足月引产的初产妇进行的回顾性研究。数据从这些妇女分娩所在产科病房的电子数据库中收集。
我们抽取了1274名平均年龄为26.3±5.9岁的妇女。建档时的平均BMI为26.5kg/m²，其中28.8%超重，24.3%肥胖。在样本中，70.4%经阴道正常分娩，15.4%剖宫产（CS），14.2%器械助产。BMI增加与剖宫产几率独立相关，超重和肥胖妇女剖宫产的可能性分别高出1.58倍和2.75倍。BMI正常的妇女剖宫产率为10.2%，超重妇女升至15.8%，肥胖妇女为24.9%（p<0.001）。BMI增加对我们队列中的器械助产率没有影响。与BMI正常的妇女相比，超重和肥胖妇女1分钟和5分钟时的阿氏评分显著更低。
我们发现引产妇女BMI增加与剖宫产率升高和阿氏评分降低相关。这些发现凸显了助产士在促使妇女在怀孕前进行体重管理方面的重要作用。
