BACKGROUND AND PURPOSE:

• Standardized guidelines for management of women with BMI ≥30 in pregnancy are not currently available
• Gibbs Pickens et al. (Obstetrics & Gynecology, 2017) compared elective induction vs expectant management to assess impact on cesarean delivery and adverse perinatal outcomes in obese women, 39-41 weeks

METHODS:

• Retrospective cohort study (2007-2011)
• California Linked Patient Discharge Data–Birth Cohort File
• Inclusion: Singleton, cephalic, nonanomalous deliveries to obese women, ≥39 weeks
• Exclusion: Pre-existing medical conditions, previous cesarean, abnormal placentation, issoimmunization
• Multivariable logistic regression models were used, stratified by parity for each week from 39 to 41 weeks
• Primary outcome
  • Maternal mode of delivery
• Secondary outcomes
  • Severe maternal morbidity (composite outcome)
  • Macrosomia (birth weight ≥4,500 g)
  • Shoulder dystocia, brachial plexus injury
  • Clinical chorioamnionitis
  • Infant mortality, NICU admission, neonatal transfer or extended hospital stay, meconium aspiration syndrome, respiratory distress syndrome (RDS)

RESULTS:

• 165,975 women were included
• Among nulliparous, obese women, cesarean section was less common at 39 and 40 weeks in the induction group
• Cesarean section was 35.9% in the induction group vs 41.0% in the expectant management group
  • 39 weeks: Adjusted odds ratio [OR] 0.82; 95% CI 0.77–0.88
• Severe maternal morbidity was less common among nulliparous women undergoing induction (5.6%) vs expectant management (7.6%)
  • 39 weeks: Adjusted OR 0.75; 95% CI 0.65–0.87
• NICU admission was reduced among nulliparous women undergoing induction (7.9%) when compared to expectant management (10.1%)
  • 39 weeks: Adjusted OR 0.79; 95% CI 0.70-0.89
• Benefits of induction were also seen in parous women when induction was compared to expectant management (following data at 39 weeks)
  • Cesarean delivery less common: 7.0% vs 8.7%
    • OR 0.79; 95% CI 0.73–0.86
  • Severe maternal morbidity less common: 3.3% vs 4.0%
    • OR 0.83; 95% CI 0.74–0.94
  • NICU admission less common: 5.3% vs 7.4%
    • OR 0.75; 95% CI 0.68–0.82
  • Similar findings were found at 40 weeks with reduced odds of cesarean delivery, maternal morbidity, and neonatal intensive care unit admission among both obese nulliparous and parous patients

CONCLUSION:

• Elective labor induction in obese women was associated with lower risk for maternal and neonatal morbidity
• Authors recommend future research with more rigorous (prospective) study design

Learn More – Primary Sources:

Term Elective Induction of Labor and Pregnancy Outcomes Among Obese Women and Their Offspring

Related ObG Topics:

Maternal Overweight, Obesity and Congenital Malformations – How Strong is the Link?

Obesity in pregnancy – classification and clinical implications

Obesity and Stillbirth At Term – What is the Actual Risk?

Increasing BMI and Adverse Pregnancy Outcomes: What Are the Risks?