• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

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

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • D’Souza et al. (Am. J. Obstet. Gynecol., 2019) sought to analyze pregnancy outcomes stratified by obesity classes (WHO classification system)

METHODS:

  • Systematic review and meta-analysis
  • Data sources
    • Medline, Embase, PubMed, www.clinicaltrials.gov, and Cochrane from inception to February 2019
    • Reference lists of included articles were searched
  • Study inclusion criteria
    • Single-center and population-based cohort studies (no RCTs were identified)
    • Reported on pregnancy outcomes in women with BMI ≥30 kg/m2 stratified by Obesity Classes
  • BMI categories for stratification
    • Normal weight (standard BMI): 18.5 to 24.9 kg/m2
    • Overweight (not obese): 25.0 to 29.9 kg/m2
    • Class 1 obesity: 30.0 to 34.9 kg/m2
    • Class 2 obesity: 35.0 to 39.9 kg/m2
    • Class 3 obesity: ≥40.0 kg/m2
  • Study design and data analysis
    • Random-effects meta-analysis to determine
      • Pooled estimated and 95% confidence intervals for pregnancy outcomes in each BMI category
      • relative risk (RR) vs standard BMI

RESULTS:

  • 13 studies | 3,722,477 pregnancies
  • Risk of adverse outcomes vs standard BMI increased in a linear fashion as well as with each obesity class | Highest risks noted for Class 3

Perinatal Risks

  • Maternal
    • GDM | Hypertensive disorders | Unplanned cesarean deliveries
  • Infant
    • Prematurity | Stillbirth | Macrosomia | Birth trauma | RDS | Hypoglycemia | Early postnatal infection | NICU admission | Neonatal death

Highest Risk in Obesity Class 3

  • Increased maternal risks
    • GDM: 17% vs 3.9% | RR 4.6 (95% CI, 3.6 to 5.9)
    • Hypertensive disorders of pregnancy: 15.9% vs 3.5% | RR 4.6 (95% CI, 3.4 to 6.0)
    • Cesarean delivery: 47.7% vs 26.0% | RR 1.86 (95% CI, 1.75 to 1.97)
  • Increased newborn risks
    • Hypoglycemia: 4.1% vs 1.4% | RR 3.3 (95% CI, 2.8 to 3.8)
    • Macrosomia: 12.9% vs 6.2% | RR 2.6 (95% CI, 1.4 to 4.7)
    • Infection: 2.8% vs 1.3% | RR 2.3 (95% CI, 1.6 to 3.3)
    • Birth trauma: 1.3% vs 0.9% | RR 2.1 (95% CI, 1.2 to 3.8)
    • Respiratory distress: 5.1% vs 2.7% | RR 2.0 (95% CI, 1.8 to 2.2)
    • Death: 1.4% vs 0.9% | 1.8 (95% CI, 1.2 to 2.9)
    • NICU admission: 13.5% vs 9.5% | RR 1.6 (95% CI, 1.4 to 1.9)

CONCLUSION:

  • The authors conclude that overall, “this study showed a linear association among almost all adverse pregnancy outcomes”
  • The study includes tables for counseling stratified by obesity class that can potentially be used for counseling

Learn More – Primary Sources:

Maternal body mass index and pregnancy outcomes: a systematic review and metaanalysis

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst®

Try it Free  »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Maternal Overweight, Obesity and Congenital Malformations – How Strong is the Link?
Practical obstetrics info for your women's healthcare practice
Obesity in Pregnancy: Classification and Clinical Implications
Objective Data to Inform Weight Gain Recommendations for Pregnant Women with Obesity
Does Elective Induction Lower Risk for Adverse Obstetrical Outcomes in the Setting of Obesity

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site