Center for Clinical Epidemiology, Lady Davis Institute, McGill University, Montreal, Canada.
Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada.
J Perinat Med. 2021 Feb 25;49(7):791-796. doi: 10.1515/jpm-2021-0043. Print 2021 Sep 27.
To evaluate if induction of labor (IOL) in obese women at 39 weeks of gestation decreases the risk of cesarean delivery (CD).
We conducted a retrospective propensity score matched study using the Center for Disease Control's (CDC's) Period Linked Birth-Infant Death data. The study population consisted of cephalic singleton births to women with BMI greater or equal to 30.0 kg/m who delivered at or beyond 39 weeks between 2013 and 2017. Women with prior CD were excluded. Women who underwent IOL at 39 weeks were propensity score matched 1:5 on the basis of CD risk factors to women who did not undergo IOL at 39 weeks but may have had an IOL at a later gestational age. Conditional logistic regression compared CD rates and maternal outcomes between obese women induced at 39 weeks with those not induced at 39 weeks.
Our cohort consisted of 197,343 obese women induced at 39 weeks and 986,715 obese women not induced at 39 weeks. Overall, the risk of CD among women who had an IOL at 39 weeks was lower than those without an IOL at 39 weeks, 0.59 (0.58-0.60). The decrease in CD risk was more pronounced in multiparas, 0.47 (0.46-0.49) than nulliparas, 0.81 (0.79-0.83). When stratified by BMI, the effect of IOL on lowering CD risk was similar across all obesity classes. Aside from an increased risk of instrumental deliveries, morbidities were comparable in both groups.
IOL at 39 weeks among obese women appears to lower the risk of CD, without compromising maternal outcomes.
评估 39 孕周肥胖孕妇引产是否降低剖宫产率（CD）。
我们使用疾病控制中心（CDC）的时期链接出生-婴儿死亡数据进行了回顾性倾向评分匹配研究。研究人群包括 BMI 大于或等于 30.0kg/m2且在 2013 年至 2017 年期间在 39 孕周或之后分娩的头位单胎产妇。排除既往有 CD 的孕妇。在 39 孕周行引产的孕妇，根据 CD 危险因素与未在 39 孕周行引产但可能在更晚孕周行引产的孕妇进行倾向评分 1:5 匹配。条件逻辑回归比较了在 39 孕周引产的肥胖孕妇与未在 39 孕周引产的肥胖孕妇的 CD 发生率和产妇结局。
我们的队列包括 197343 例在 39 孕周行引产的肥胖孕妇和 986715 例未在 39 孕周行引产的肥胖孕妇。总体而言，在 39 孕周行引产的孕妇 CD 发生率低于未在 39 孕周行引产的孕妇，为 0.59（0.58-0.60）。在多产妇中，CD 风险降低更为明显，为 0.47（0.46-0.49），而在初产妇中，为 0.81（0.79-0.83）。按 BMI 分层时，引产对降低 CD 风险的影响在所有肥胖人群中相似。除了器械分娩的风险增加外，两组产妇的发病率相似。
39 孕周肥胖孕妇引产似乎可降低 CD 风险，而不影响产妇结局。
