Journal Article

Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study

Vaughan, Geraldine A, Wang, Alex, Jackson Pulver, Lisa, Ellwood, David, Sullivan, Elizabeth A., Homer, Caroline SE, Javid, Nasrin, Knight, Marian, Pollock, Wendy, Callaway, Leonie, McLintock, Claire, Peek, Michael J., Denney-Wilson, Elizabeth, Dickinson, Jan E., Li, Zhuoyang

2015

Overview

Background Super-obesity is associated with significantly elevated rates of obstetric complications, adverse perinatal outcomes and interventions. The purpose of this study was to determine the prevalence, risk factors, management and perinatal outcomes of super-obese women giving birth in Australia. Methods A national population-based cohort study. Super-obese pregnant women (body mass index (BMI) >50 kg/m 2 or weight >140 kg) who gave birth between January 1 and October 31, 2010 and a comparison cohort were identified using the Australasian Maternity Outcomes Surveillance System (AMOSS). Outcomes included maternal and perinatal morbidity and mortality. Prevalence estimates calculated with 95 % confidence intervals (CIs). Adjusted odds ratios (ORs) were calculated using multivariable logistic regression. Results 370 super-obese women with a median BMI of 52.8 kg/m 2 (range 40.9–79.9 kg/m 2 ) and prevalence of 2.1 per 1 000 women giving birth (95 % CI: 1.96–2.40). Super-obese women were significantly more likely to be public patients (96.2 %), smoke (23.8 %) and be socio-economically disadvantaged (36.2 %). Compared with other women, super-obese women had a significantly higher risk for obstetric (adjusted odds ratio (AOR) 2.42, 95 % CI: 1.77–3.29) and medical (AOR: 2.89, 95 % CI: 2.64–4.11) complications during pregnancy, birth by caesarean section (51.6 %) and admission to special care (HDU/ICU) (6.2 %). The 372 babies born to 365 super-obese women with outcomes known had significantly higher rates of birthweight ≥4500 g (AOR 19.94, 95 % CI: 6.81–58.36), hospital transfer (AOR 3.81, 95 % CI: 1.93–7.55) and admission to Neonatal Intensive Care Unit (NICU) (AOR 1.83, 95 % CI: 1.27–2.65) compared to babies of the comparison group, but not prematurity (10.5 % versus 9.2 %) or perinatal mortality (11.0 (95 % CI: 4.3–28.0) versus 6.6 (95 % CI: 2.6- 16.8) per 1 000 singleton births). Conclusions Super-obesity in pregnancy in Australia is associated with increased rates of pregnancy and birth complications, and with social disadvantage. There is an urgent need to further address risk factors leading to super-obesity among pregnant women and for maternity services to better address pre-pregnancy and pregnancy care to reduce associated inequalities in perinatal outcomes.

• Publisher: BioMed Central,Springer Nature B.V
• Subject: Adult / Apgar Score / Australia - epidemiology / Birth Weight / Body Mass Index / Body Weight / Cesarean Section - adverse effects / Cohort analysis / Data collection / Diabetes / Female / Gastrointestinal surgery / Gynecology / Health risk assessment / Humans / Infant, Newborn / Laparoscopy / Marital status / Maternal and Child Health / Maternal Health Services / Medicine / Medicine & Public Health / Obesity / Obesity, Morbid - epidemiology / Obstetrics / Odds Ratio / Perinatal Mortality / Population-based studies / Pre-Eclampsia - epidemiology / Preeclampsia / Pregnancy / Pregnancy Complications - epidemiology / Pregnancy Outcome - epidemiology / Prenatal care / Prospective Studies / Reproductive Medicine / Reproductive technologies / Research Article / Risk Factors / Socioeconomic factors / Systematic review / Trends / Womens health / Young Adult