Are Obese Women Less Likely to Have Spontaneous Labor Onset?

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Recall what is known about obesity and labor
2. List the findings of this study

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

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BACKGROUND AND PURPOSE:

37% of reproductive age women (20–39 years old) are obese (National Health and Nutrition Examination Survey 2013 to 2014)
Previous studies indicate that obese women are at increased risk of postterm pregnancies and abnormal labor progression that may be related to delay in spontaneous labor
Frolova et al. (American Journal of Perinatology, 2017) compared both rates and progression of spontaneous labor onset in obese and nonobese women

METHODS:

Secondary analysis of a retrospective cohort
Inclusion criteria: Singleton pregnancy, gestational age ≥37 weeks and admission for delivery
Subjects were categorized as either obese (BMI ≥ 30) or nonobese
The cohort was stratified based on week of delivery
Outcomes were spontaneous delivery, vaginal delivery, augmentation with oxytocin

RESULTS:

11,752 women who met inclusion criteria
Obese women had fewer spontaneous deliveries at every week mark compared to nonobese
- 37 weeks: 6.1 vs. 9.3% p<0.001
- 38 weeks: 12.8 vs. 19.2%, p < 0.001
- 39 weeks: 26.0 vs. 37.0%, p < 0.001
- 40 weeks: 39.6 vs. 50.2%, p < 0.001
- 41 weeks: 30.8 vs. 38.0%, p < 0.012
Obese women presenting in spontaneous labor between 37 to 40 weeks were
- Less likely to have a vaginal delivery (83.0 vs. 88.8%, p < 0.001)
- More likely to have their labor augmented with oxytocin (49.8 vs. 42.8%, p < 0.001)

CONCLUSION:

Obese women after or at 37 weeks are less likely to have spontaneous births and deliver between 37 and 40 weeks even with oxytocin augmentation
Unlike induction of labor in the general population, obesity is a risk factor for complications associated with failed induction and cesarean delivery
More research is needed to determine optimal management when considering induction vs expectant management in the obese population

Learn More – Primary Sources:

Spontaneous Labor Onset and Outcomes in Obese Women at Term

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Are Obese Women Less Likely to Have Spontaneous Labor Onset?