Grand Rounds

Does Excessive Gestational Weight Gain Reduce Chances of a Successful Trial of Labor After Cesarean?

BACKGROUND AND PURPOSE:

Mei et al. (American Journal of Perinatology, 2019) sought to determine the relationship between gestational weight gain (GWG) and TOLAC

Retrospective cohort study (2007-2016)
Participants
- Women undergoing TOLAC
- Women were divided into three groups: (1) gaining less than, (2) meeting, or (3) exceeding IOM recommendations (see ‘Related ObG Topics’ below)
Additional data collected, including obstetrical and perinatal variables
Primary outcome
- Successful VBAC
Secondary outcomes
- Perinatal morbidity markers

614 women included in the study | 72.3% had a successful VBAC
Women grouped by GWG
- GWG below guidelines: 24.3%
- GWG within guidelines: 36.5%
- GWG above guidelines: 39.3%
There was no difference in VBAC success rate among the three groups
- No difference seen when adjusting for prepregnancy BMI
- No difference seen when analysis included whether a patient moved up in obesity class during pregnancy
Women who met guidelines were
- More likely to enter spontaneous labor (83%) than those below (72.5%) or above guidelines (75.1%); p = 0.033
- Less likely to have elevated BP (5.4%) than those below (11.4%) or above the guidelines (14.1%); p = 0.007

There was no association between gestational weight gain and successful VBAC
Authors conclude that excessive weight gain should not be considered a risk factor for a failed TOLAC

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