Brizan Jessica B, Amabebe Emmanuel
School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.
Department of Oncology and Metabolism, University of Sheffield, Sheffield S10 2SF, UK.
Life (Basel). 2022 Jun 17;12(6):906. doi: 10.3390/life12060906.
Background: Maternal obesity is associated with several adverse reproductive outcomes. It is a growing public health burden in sub-Saharan Africa, a region with low resources and capacity to care for the large, affected population. Objectives: To assess the evidence of maternal obesity as a risk factor for caesarean delivery in women in sub-Saharan Africa. Methods: A systematic review of relevant original articles using PubMed, MEDLINE, and CINAHL was performed. Google Scholar and the reference lists of relevant systematic reviews and meta-analyses were also searched for other eligible studies. Observational studies assessing maternal body mass index (BMI) ≥ 30 kg/m2 before or during gestation and caesarean delivery as birth outcome were included. Results: All 17 studies were published between 2009 and 2021 and included 227,675 (236−153,102) participants. The prevalence of maternal obesity ranged from 3.9 to 44%. All except two studies (88%) indicated an association of obesity and risk of caesarean delivery in pregnant women in sub-Saharan Africa. Overweight/obese women had up to 4-fold increased risk of caesarean delivery compared to normal weight women. Three studies also reported a direct relationship between morbid obesity and prevalence of caesarean delivery in the sub-region. The risk of caesarean delivery appears to increase with increasing BMI e.g., >5 times in women with BMI ≥ 40 kg/m2 than in normal weight women. Conclusions: In sub-Saharan Africa, increased BMI in pregnancy is a risk factor for subsequent caesarean delivery. The risk of caesarean delivery appears to increase with increasing BMI. A robust meta-analysis and other patho-mechanistic studies can be conducted to confirm causal association. Culturally appropriate weight management and nutritional interventions should be implemented to reduce the incidence of obesity-induced caesarean delivery in sub-Saharan Africa.
孕产妇肥胖与多种不良生殖结局相关。在撒哈拉以南非洲地区，这是一个日益加重的公共卫生负担，该地区资源匮乏，照顾大量受影响人群的能力有限。
评估孕产妇肥胖作为撒哈拉以南非洲地区女性剖宫产危险因素的证据。
使用PubMed、MEDLINE和CINAHL对相关原始文章进行系统综述。还在谷歌学术以及相关系统综述和荟萃分析的参考文献列表中搜索其他符合条件的研究。纳入评估妊娠前或妊娠期间孕产妇体重指数（BMI）≥30 kg/m² 以及剖宫产作为分娩结局的观察性研究。
所有17项研究均发表于2009年至2021年之间，共纳入227,675名（236 - 153,102）参与者。孕产妇肥胖的患病率在3.9%至44%之间。除两项研究外（88%），所有研究均表明撒哈拉以南非洲地区肥胖与孕妇剖宫产风险相关。超重/肥胖女性剖宫产风险比正常体重女性高4倍。三项研究还报告了该次区域病态肥胖与剖宫产患病率之间的直接关系。剖宫产风险似乎随着BMI升高而增加，例如，BMI≥40 kg/m² 的女性剖宫产风险比正常体重女性高5倍以上。
在撒哈拉以南非洲地区，孕期BMI升高是随后剖宫产的危险因素。剖宫产风险似乎随着BMI升高而增加。可进行强有力的荟萃分析和其他病理机制研究以证实因果关联。应实施符合文化背景的体重管理和营养干预措施，以降低撒哈拉以南非洲地区肥胖导致的剖宫产发生率。
