P Deruelle1, E Servan-Schreiber2, O Riviere3, C Garabedian2, F Vendittelli4. 1. EA 4489, environnement périnatal et santé, University Lille, CHU de Lille, 59000 Lille, France. Electronic address: philippe.deruelle@univ-lille2.fr. 2. EA 4489, environnement périnatal et santé, University Lille, CHU de Lille, 59000 Lille, France. 3. Association des utilisateurs de dossiers informatisés en pédiatrie, obstétrique et gynécologie (AUDIPOG), université Claude-Bernard Lyon 1 - Laennec, 7, rue Guillaume-Paradin, 69372 Lyon cedex 8, France. 4. Association des utilisateurs de dossiers informatisés en pédiatrie, obstétrique et gynécologie (AUDIPOG), université Claude-Bernard Lyon 1 - Laennec, 7, rue Guillaume-Paradin, 69372 Lyon cedex 8, France; Pôle femme et enfant, centre hospitalier universitaire de Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; EA 4681, Peprade (Périnatalité, grossesse, environnement, pratiques médicales et développement), Clermont université, université d'Auvergne, 63003 Clermont-Ferrand, France.
Abstract
OBJECTIVES: To evaluate, in a French multicenter cohort, the risk of C-section based on a high pre-pregnancy body mass index (BMI). Secondary objectives were to assess the risk of elective C-section, severe post-partum hemorrhage (>1L), severe perineal tears (3rd and 4th degree) and neonatal complications according to pre-pregnancy BMI. STUDY DESIGN: This historical cohort study analyzed records from the French AUDIPOG perinatal database. Inclusion criteria were deliveries≥22 weeks (or with a birth weight≥500g). Women with BMI<18.5kg/m2 (n=31,766) were excluded. After these exclusions, the study sample included 314,851 women between 1999 and 2009. Patients were classified among four BMI subgroups (normal: 18.5-24.9kg/m2, overweight: 25-29.9kg/m2, class I and II obesity: 30-39.9kg/m2 and class III obesity:≥40kg/m2). BMI was calculated using pre-pregnancy self-reported weight. Results were expressed as crude and adjusted relative risks (aRR). RESULTS: A C-section occurred in 16.4%, 22.7%, 28.8% and 39.4% of normal BMI, overweight, obese and class III obese women, respectively (P<10-4). aRR of C-section increased with BMI: 1.26 [95%CI: 1.22-1.30] for BMI between 25-29.9kg/m2; 1.39 [95%CI: 1.34-1.45] for BMI between 30-39.9kg/m2 and 1.72 [95%CI: 1.57-1.90] for BMI≥40kg/m2; but not the elective C-section. Neonatal complications were more frequent with increasing maternal BMI (BMI 25-29.9: aRR=1.09 [95%CI: 1.06-1.12]; BMI 30-39.9: aRR=1.20 [95%CI: 1.16-1.25]; BMI≥40: aRR=1.33 [95%CI: 1.21-1.45]). CONCLUSION: Our study confirmed that pre-pregnancy BMI is an important factor to consider because its elevation is associated with adverse obstetrical outcomes, especially cesarean delivery and neonatal complications.
OBJECTIVES: To evaluate, in a French multicenter cohort, the risk of C-section based on a high pre-pregnancy body mass index (BMI). Secondary objectives were to assess the risk of elective C-section, severe post-partum hemorrhage (>1L), severe perineal tears (3rd and 4th degree) and neonatal complications according to pre-pregnancy BMI. STUDY DESIGN: This historical cohort study analyzed records from the French AUDIPOG perinatal database. Inclusion criteria were deliveries≥22 weeks (or with a birth weight≥500g). Women with BMI<18.5kg/m2 (n=31,766) were excluded. After these exclusions, the study sample included 314,851 women between 1999 and 2009. Patients were classified among four BMI subgroups (normal: 18.5-24.9kg/m2, overweight: 25-29.9kg/m2, class I and II obesity: 30-39.9kg/m2 and class III obesity:≥40kg/m2). BMI was calculated using pre-pregnancy self-reported weight. Results were expressed as crude and adjusted relative risks (aRR). RESULTS: A C-section occurred in 16.4%, 22.7%, 28.8% and 39.4% of normal BMI, overweight, obese and class III obesewomen, respectively (P<10-4). aRR of C-section increased with BMI: 1.26 [95%CI: 1.22-1.30] for BMI between 25-29.9kg/m2; 1.39 [95%CI: 1.34-1.45] for BMI between 30-39.9kg/m2 and 1.72 [95%CI: 1.57-1.90] for BMI≥40kg/m2; but not the elective C-section. Neonatal complications were more frequent with increasing maternal BMI (BMI 25-29.9: aRR=1.09 [95%CI: 1.06-1.12]; BMI 30-39.9: aRR=1.20 [95%CI: 1.16-1.25]; BMI≥40: aRR=1.33 [95%CI: 1.21-1.45]). CONCLUSION: Our study confirmed that pre-pregnancy BMI is an important factor to consider because its elevation is associated with adverse obstetrical outcomes, especially cesarean delivery and neonatal complications.
Authors: K S D Trombe; L S Rodrigues; L M P Nascente; V M F Simões; R F L Batista; R C Cavalli; C Grandi; V C Cardoso Journal: Braz J Med Biol Res Date: 2020-12-07 Impact factor: 2.590