Bjorklund Jenny, Wiberg-Itzel Eva, Wallstrom Tove
Department of Clinical Science and Education Karolinska Institute, Soderhospital, Stockholm, Sweden.
Womens Clinic, Soderhospital, Stockholm, Sweden.
PLoS One. 2022 Feb 25;17(2):e0263685. doi: 10.1371/journal.pone.0263685. eCollection 2022.
Obesity is increasing in Sweden and is also of huge global concern. Obesity increases the risk of complications during pregnancy and the need for the induction of labor. Induction of labor increases the number of complications during delivery, leading to women with more negative birth experience. This study investigated how maternal body mass index (BMI) during antenatal care enrollment affects labor outcomes (proportion of cesarean section at induction of labor).
This was a retrospective cohort study of 3772 women with mixed parity and induction of labor at Soderhospital, Stockholm, in 2009-2010 and 2012-2013. The inclusion criteria were simplex, ≥34 gestational weeks, cephalic presentation and no previous cesarean section. The women were grouped according to BMI, and statistical analyzes were performed to compare the proportion of cesarean sections after induction of labor. The primary outcome was the proportion of cesarean section after induction of labor divided by group of maternal BMI. The secondary outcomes were postpartum hemorrhage >1000 ml, time of labor, fetal outcome data, and indication for emergency cesarean section.
The induction of labor in women with a high BMI resulted in a significantly increased risk of cesarean section, with 18.4-24.1% of deliveries, depending on the BMI group. This outcome persisted after adjustment in women with BMI 25-29.9 (aOR 1.4; 95% CI; 1.1-1.7) and BMI 30-34.9 (aOR 1.5; 95% CI; 1.1-2.1). There was also a significantly higher risk for CS among primiparous women (aOR 3.6; 95% CI; 2.9-45) and if the newborn weighted ≥ four kilos (aOR 1.6; 95% CI; 1.3-2.0).
Our findings show that a higher BMI increased the risk of cesarean section after induction of labor in the groups with BMI 25-34.9. Parity seems to be the strongest risk factor for CS regardless other variables.
肥胖在瑞典呈上升趋势，也是全球高度关注的问题。肥胖会增加孕期并发症的风险以及引产的必要性。引产会增加分娩期间的并发症数量，导致女性有更多负面的分娩体验。本研究调查了产前检查登记时孕妇的体重指数（BMI）如何影响分娩结局（引产时剖宫产的比例）。
这是一项对2009 - 2010年以及2012 - 2013年在斯德哥尔摩索德医院进行引产的3772名不同胎次女性的回顾性队列研究。纳入标准为单胎、孕周≥34周、头先露且既往无剖宫产史。根据BMI对女性进行分组，并进行统计分析以比较引产术后剖宫产的比例。主要结局是引产术后剖宫产的比例除以孕妇BMI分组。次要结局包括产后出血>1000毫升、产程时间、胎儿结局数据以及急诊剖宫产指征。
BMI较高的女性引产导致剖宫产风险显著增加，根据BMI分组，剖宫产比例在18.4% - 24.1%之间。在BMI为25 - 29.9的女性（调整后比值比1.4；95%置信区间；1.1 - 1.7）和BMI为30 - 34.9的女性（调整后比值比1.5；95%置信区间；1.1 - 2.1）中，这一结果在调整后仍然存在。初产妇剖宫产风险也显著更高（调整后比值比3.6；95%置信区间；2.9 - 4.5），以及新生儿体重≥4千克时（调整后比值比1.6；95%置信区间；1.3 - 2.0）。
我们的研究结果表明，较高的BMI增加了BMI为25 - 34.9组引产术后剖宫产的风险。无论其他变量如何，胎次似乎是剖宫产最强的风险因素。
