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#Grand Rounds

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

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BACKGROUND AND PURPOSE:

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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

  • 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

Learn More – Primary Sources:

Impact of Gestational Weight Gain on Trial of Labor after Cesarean Success

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Related ObG Topics:

Practical obstetrics info for your women's healthcare practice
Recommended Weight Gain and Obesity Management in Pregnancy
Is There an Association Between High or Low Weight Gain and Maternal and Infant Outcomes?
Practical obstetrics info for your women's healthcare practice
Obesity in pregnancy – classification and clinical implications
Does Lifestyle Intervention Ameliorate Pregnancy Weight Gain and Does It Affect Perinatal Outcomes?
Does Exercise During Pregnancy Impact Hypertension or Macrosomia?

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