Horwood Geneviève, Erwin Erica, Guo Yanfang, Aston Brett, Souza Sara C S, Gaudet Laura M
Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Int J Obes (Lond). 2025 May;49(5):835-843. doi: 10.1038/s41366-024-01709-x. Epub 2025 Mar 17.
BACKGROUND/OBJECTIVE: As the pregnancy progresses, a decision about planned mode of delivery must be made. There is no consensus on optimal mode of delivery among pregnant women with obesity. We aimed to assess the risks associated with planned mode of delivery in women with obesity.
This large population-based retrospective cohort study included 27472 nulliparous women with obesity who had live, singleton, and uncomplicated term gestations between April 1st 2012 and March 31st 2019. Planned mode of delivery included waiting for spontaneous labor, a plan for induction of labor, and planned non-labor cesarean section (NLCS). NLCS was defined as an elective CS that would happen before the pregnant woman goes into labor. The most common reasons for NLCS include maternal request, fetal position, and repeated CS. Adverse Outcome Index (AOI) was the primary outcome, a binary composite of 10 maternal-neonatal outcomes. Overall, maternal-specific, and neonatal-specific AOI scores were analyzed. Analyses were conducted using multivariable regression models and were stratified by each week of gestational age and by obesity class.
Planned NLCS was associated with reduced risk of overall, maternal-specific, and neonatal-specific AOI by 41% (adjusted risk ratio [aRR]: 0.59, 95% confidence interval [CI]: 0.50-0.70), 54% (aRR: 0.46, 95% CI: 0.35-0.60), and 30% (aRR: 0.70, 95% CI: 0.57-0.87) respectively when compared to spontaneous labor at term gestation. There was no statistically significant difference in overall AOI when comparing planned induction of labor to spontaneous labor (aRR: 1.03, 95% CI: 0.96-1.10).
Among women with obesity, NLCS may be considered as an option for planned mode of delivery due to the decreased AOI risk. However, further research on the association between NLCS and severe outcomes is needed. Shared decision making between patient and practitioner regarding plan for delivery remains paramount in the provision of quality obstetrical care.
背景/目的：随着孕期进展，必须做出关于计划分娩方式的决定。肥胖孕妇的最佳分娩方式尚无共识。我们旨在评估肥胖女性计划分娩方式相关的风险。
这项基于人群的大型回顾性队列研究纳入了27472名肥胖初产妇，她们在2012年4月1日至2019年3月31日期间有活产、单胎且足月妊娠无并发症。计划分娩方式包括等待自然分娩、引产计划和计划非临产剖宫产（NLCS）。NLCS定义为在孕妇临产之前进行的择期剖宫产。NLCS最常见的原因包括产妇要求、胎位和再次剖宫产。不良结局指数（AOI）是主要结局，是10种母婴结局的二元综合指标。对总体、产妇特异性和新生儿特异性AOI评分进行了分析。分析采用多变量回归模型，并按孕周和肥胖类别分层。
与足月妊娠自然分娩相比，计划NLCS使总体、产妇特异性和新生儿特异性AOI风险分别降低41%（调整风险比[aRR]：0.59，95%置信区间[CI]：0.50 - 0.70）、54%（aRR：0.46，95%CI：0.35 - 0.60）和30%（aRR：0.70，95%CI：0.57 - 0.87）。将计划引产与自然分娩相比，总体AOI无统计学显著差异（aRR：1.03，95%CI：0.96 - 1.10）。
在肥胖女性中，由于AOI风险降低，NLCS可被视为计划分娩方式的一种选择。然而，需要进一步研究NLCS与严重结局之间的关联。在提供优质产科护理方面，患者与从业者之间就分娩计划进行共同决策仍然至关重要。
