Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):9934-9939. doi: 10.1080/14767058.2022.2076591. Epub 2022 May 19.
To evaluate the impact of pre-pregnancy obesity on the cesarean delivery rate in nulliparous pregnant people undergoing induction of labor.
This is a retrospective cohort study of nulliparous pregnant people with a normal weight and obesity who underwent induction of labor between 37 and 41 weeks gestation at a single institution from 2012 to 2018. Weight category was based on pre-pregnancy body mass index. The primary outcome was rate of cesarean delivery. Additional demographic and clinical characteristics were analyzed. A chi square test was used to compare the cesarean delivery rates. Multivariate logistic regression was used to generate adjusted odds ratios (aOR) and 95% confidence intervals (CI) controlling for potential cofounders.
Of the 557 pregnancies identified, 88/285 (31%) of pregnant people with a normal weight had a cesarean delivery while 165/263 (63%) of pregnant people with obesity had a cesarean delivery (cOR 3.8, 95% CI 2.6-5.4). After adjustment, pregnant people with obesity remained more likely to have a cesarean delivery compared to pregnant people with a normal weight (aOR 2.7, 95% CI 1.8-4.0). Further, cesarean delivery was more likely in those with an unfavorable modified Bishop score (aOR 3.4, 95% CI 1.8-6.5) and gestational weight gain above the Institute of Medicine recommendation (aOR 2.6, 95% CI 1.8-3.9). The rate of cesarean delivery was not different by class of obesity ( = .32).
Pre-pregnancy obesity is associated with higher cesarean delivery rates in nulliparous pregnant people undergoing induction of labor compared with normal pre-pregnancy body mass index. Gestational weight gain above the Institute of Medicine recommendations and having an unfavorable modified Bishop score at the time of induction are associated with increased cesarean delivery rates.
评估初产妇孕前肥胖对 37 至 41 孕周行引产孕妇剖宫产率的影响。
这是一项回顾性队列研究，纳入了 2012 年至 2018 年在单家医疗机构因孕 37 至 41 周行引产的正常体重和肥胖初产妇，体重分类基于孕前体重指数。主要结局为剖宫产率。分析了其他人口统计学和临床特征。采用卡方检验比较剖宫产率。采用多变量逻辑回归生成调整后的比值比（aOR）和 95%置信区间（CI），以控制潜在混杂因素。
共纳入 557 例妊娠，其中 88/285（31%）例正常体重孕妇行剖宫产，165/263（63%）例肥胖孕妇行剖宫产（cOR 3.8，95%CI 2.6-5.4）。校正后，肥胖孕妇行剖宫产的可能性仍高于正常体重孕妇（aOR 2.7，95%CI 1.8-4.0）。此外，改良 Bishop 评分不佳（aOR 3.4，95%CI 1.8-6.5）和体重增加超过医学研究所建议（aOR 2.6，95%CI 1.8-3.9）的孕妇行剖宫产的可能性更高。肥胖类型与剖宫产率无关（ =.32）。
与正常孕前体重指数相比，初产妇行引产时孕前肥胖与剖宫产率升高相关。体重增加超过医学研究所建议以及引产时改良 Bishop 评分不佳与剖宫产率升高相关。
