Lisa S Callegari1, Lauren A Sterling2, Sarah T Zelek2, Stephen E Hawes2, Susan D Reed3. 1. Department of Epidemiology, University of Washington School of Public Health, Seattle, WA; Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA; Health Services Research and Development, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA. Electronic address: lcallega@uw.edu. 2. Department of Epidemiology, University of Washington School of Public Health, Seattle, WA. 3. Department of Epidemiology, University of Washington School of Public Health, Seattle, WA; Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA.
Abstract
OBJECTIVE: We investigated the effect of interpregnancy body mass index (BMI) change on success of term vaginal birth after cesarean (VBAC) among normal, overweight and obese women. STUDY DESIGN: Using 1992-2009 Washington State birth certificate data linked with hospitalization records, we conducted a population-based retrospective cohort study of nulliparous women (BMI ≥18.5 kg/m(2)) with a primary cesarean in their first birth and a term trial of labor in their second. Interpregnancy weight change (difference between first and second prepregnancy BMIs) was categorized as maintenance (<1 BMI unit change), loss (≥1 unit), moderate gain (≥1 and <2 units), high gain (≥2 units). We estimated relative risks of VBAC success using generalized linear models with a log-link function, adjusting for maternal age, race/ethnicity, nativity, marital status, education, smoking, primary cesarean indication, interpregnancy interval, birth year for second birth, and prenatal care adequacy. RESULTS: Among 8302 women who attempted a term trial of labor, 65% had a successful VBAC. Women with normal BMI before their first pregnancy experienced an 8% decrease in VBAC success with moderate gain (relative risk [RR], 0.92; 95% confidence interval [CI], 0.87-0.98) and a 12% decrease in success with high gain (RR, 0.88; 95% CI, 0.83-0.93), compared with normal weight women who maintained weight. Weight loss increased VBAC success in women who were overweight (RR, 1.12; 95% CI, 1.01-1.25) or obese before their first delivery (RR, 1.24; 95% CI, 1.04-1.49), compared with overweight and obese women, respectively, who maintained weight. CONCLUSION: Women can improve their chance of successful VBAC through interpregnancy weight management. Published by Mosby, Inc.
OBJECTIVE: We investigated the effect of interpregnancy body mass index (BMI) change on success of term vaginal birth after cesarean (VBAC) among normal, overweight and obesewomen. STUDY DESIGN: Using 1992-2009 Washington State birth certificate data linked with hospitalization records, we conducted a population-based retrospective cohort study of nulliparous women (BMI ≥18.5 kg/m(2)) with a primary cesarean in their first birth and a term trial of labor in their second. Interpregnancy weight change (difference between first and second prepregnancy BMIs) was categorized as maintenance (<1 BMI unit change), loss (≥1 unit), moderate gain (≥1 and <2 units), high gain (≥2 units). We estimated relative risks of VBAC success using generalized linear models with a log-link function, adjusting for maternal age, race/ethnicity, nativity, marital status, education, smoking, primary cesarean indication, interpregnancy interval, birth year for second birth, and prenatal care adequacy. RESULTS: Among 8302 women who attempted a term trial of labor, 65% had a successful VBAC. Women with normal BMI before their first pregnancy experienced an 8% decrease in VBAC success with moderate gain (relative risk [RR], 0.92; 95% confidence interval [CI], 0.87-0.98) and a 12% decrease in success with high gain (RR, 0.88; 95% CI, 0.83-0.93), compared with normal weight women who maintained weight. Weight loss increased VBAC success in women who were overweight (RR, 1.12; 95% CI, 1.01-1.25) or obese before their first delivery (RR, 1.24; 95% CI, 1.04-1.49), compared with overweight and obesewomen, respectively, who maintained weight. CONCLUSION:Women can improve their chance of successful VBAC through interpregnancy weight management. Published by Mosby, Inc.
Entities:
Keywords:
VBAC; body mass index; interpregnancy weight change; obesity; vaginal birth after cesarean
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