Cagino Kristen A, Chen Han-Yang, Becker Cabrina, Red Beverly, Chauhan Suneet P, Mendez-Figueroa Hector
Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas.
Delaware Center of Maternal-Fetal Medicine of ChristianaCare, Newark, Delaware.
Am J Perinatol. 2025 Apr;42(6):713-721. doi: 10.1055/a-2416-6060. Epub 2024 Sep 17.
Individuals with class III obesity (body mass index [BMI] ≥ 40 kg/m) are at increased risk of cesarean delivery (CD) and peripartum complications. We ascertained compositive neonatal and maternal adverse outcomes among individuals with class III obesity who labored versus had planned CD.This was a retrospective cohort study from 2016 to 2021 using the National Vital Statistics System database. Nulliparous individuals with class III obesity prepregnancy were included if they had singleton, nonanomalous pregnancies and delivered at 37 to 41 weeks of gestation. Individuals were excluded if they had hypertensive disorders or diabetes. The primary outcome was a composite neonatal adverse outcome (CNAO), consisting of Apgar score less than 5 at 5 minutes, assisted ventilation > 6 hours, neonatal seizure, or neonatal death. The secondary outcome was a composite maternal adverse outcome (CMAO) that included admission to the intensive care unit, maternal transfusion, uterine rupture, or unplanned hysterectomy. A sensitivity analysis using a CMAO without transfusion was performed. A multivariable Poisson regression model was performed to calculate adjusted relative risks (aRRs) with 95% confidence intervals (CIs).Of 192,298 individuals who met inclusion criteria, 169,676 (88.2%) labored and 22,622 (11.8%) had a planned CD. Compared with neonates delivered by planned CD, the risk of CNAO was significantly lower in those who delivered after labor (aRR: 0.79, 95% CI: 0.71-0.87). There was no significant difference in the risk of CMAO between groups (aRR: 1.11, 95% CI: 0.87-1.41). However, the risk of CMAO without transfusion was lower in individuals who labored (aRR: 0.57, 95% CI: 0.40-0.83).In nulliparous individuals with class III obesity, the risk of CNAO and of CMAO without transfusion were significantly lower in individuals who labored, versus those who had a planned CD. · Labor in class III obesity: 21% fewer adverse neonatal outcomes.. · Class III obesity: 43% less maternal morbidity with labor.. · Labor in nulliparous individuals with class III obesity is safe..
III级肥胖（体重指数[BMI]≥40 kg/m²）的个体剖宫产（CD）及围产期并发症风险增加。我们确定了III级肥胖且经阴道分娩与计划剖宫产的个体中新生儿和母亲的综合不良结局。
这是一项使用国家生命统计系统数据库进行的2016年至2021年的回顾性队列研究。纳入孕前III级肥胖的初产妇，条件为单胎、非畸形妊娠且在妊娠37至41周分娩。患有高血压疾病或糖尿病的个体被排除。主要结局是综合新生儿不良结局（CNAO），包括5分钟时阿氏评分低于5分、辅助通气>6小时、新生儿惊厥或新生儿死亡。次要结局是综合母亲不良结局（CMAO），包括入住重症监护病房、产妇输血、子宫破裂或非计划子宫切除术。进行了一项不包括输血的CMAO敏感性分析。采用多变量泊松回归模型计算调整后相对风险（aRRs）及95%置信区间（CIs）。
在符合纳入标准的192,298名个体中，169,676名（88.2%）经阴道分娩，22,622名（11.8%）接受计划剖宫产。与计划剖宫产分娩的新生儿相比，经阴道分娩者发生CNAO的风险显著更低（aRR：0.79，95%CI：0.71 - 0.87）。两组间CMAO风险无显著差异（aRR：1.11，95%CI：0.87 - 1.41）。然而，经阴道分娩个体不包括输血的CMAO风险更低（aRR：0.57，95%CI：0.40 - 0.83）。
在孕前III级肥胖的初产妇中，经阴道分娩者发生CNAO及不包括输血的CMAO风险显著低于计划剖宫产者。· III级肥胖经阴道分娩：新生儿不良结局减少21%。· III级肥胖：经阴道分娩产妇发病率降低43%。· 孕前III级肥胖初产妇经阴道分娩是安全的。
