Skip to main content

The impact of maternal obesity, age, pre-eclampsia and insulin dependent diabetes on severe maternal morbidity by mode of delivery—a register-based cohort study

Archives of Gynecology and Obstetrics volume 291, pages 311–318 (2015)Cite this article

Abstract

Purpose

To determine the rate of severe maternal morbidity related to delivery by delivery mode and to assess if the impact of studied risk factors varies by delivery mode.

Methods

A register-based study including all women having singleton delivery in Finland in 2007–2011, n = 292,253, data derived from the Finnish Medical Birth Registry and Hospital Discharge Registry. Diagnoses and interventions indicating a severe maternal complication were searched and the mode of delivery was assessed by data linkage. The impact of obesity, maternal age 35 years or more, pre-eclampsia and insulin dependent diabetes on severe maternal morbidity (all severe complications, severe infections and severe) was studied in each mode of delivery and calculated as Odds ratios.

Results

The overall incidence of severe complications was 12.8/1,000 deliveries. The total complication rate was lowest in vaginal deliveries (VD) in all risk groups. Obesity increased the risk for all severe complications and severe infections in the total population, but not significantly in specific delivery modes. Age increased the risk of hemorrhage in VD. Pre-eclampsia increased the risk for hemorrhage in all deliveries except elective CS. In women with pre-eclampsia, overall morbidity was similar in VD, attempted VD and elective CS. The presence of any studied risk factor increased the risk for complications within the risk groups by the high proportion of emergency CS performed.

Conclusions

An attempt of VD is the safest way to deliver even for high-risk women with the exception of women with pre-eclampsia, who had a similar risk in an attempt of VD and elective CS.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Kuklina E, Meikle S, Jamieson D, Whiteman M, Barfield W, Hillis S, Posner S (2009) Severe obstetric morbidity in the United States: 1998–2005. Obstet Gynecol 113(2Pt1):293–299

    PubMed Central  PubMed  Article  Google Scholar 

  2. Schutte JM, Steegers EA, Schuitemaker NW, Santema JG, de Boer K, Pel M et al (2010) Rise in maternal mortality in the Neatherlands. BJOG 117(4):399–406

    CAS  PubMed  Article  Google Scholar 

  3. Pallasmaa N, Ekblad U, Gissler M (2008) Severe maternal morbidity and the mode of delivery. AOGS 87:662–668

    Article  Google Scholar 

  4. Zwart JJ, Richters JM, Öry F, de Vries JIP, Bloemenkamp KWM, van Roosmalen J (2008) Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population-based study of 371,000 pregnancies. BJOG 115(7):842–850

    CAS  PubMed  Article  Google Scholar 

  5. Liston WA (2003) Rising caesarean section rates: can evolution and ecology explain some of the difficulties of modern childbirth? J R Soc Med 96(11):559–561

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  6. Liu S, Liston RM, Heaman M, Sauve R, Kramer MS (2007) Maternal mortality and severe morbidity associated with low-risk planned caesarean delivery versus planned vaginal delivery at term. CMAJ 176(4):455–460

    PubMed Central  PubMed  Article  Google Scholar 

  7. van Dillen J, Zwart JJ, Schutte J, Bloemenkamp KWM, van Roosmalen J (2010) Severe acute maternal morbidity and mode of delivery in the Netherlands. AOGS 89:1460–1465

    Article  Google Scholar 

  8. Pallasmaa N, Ekblad U, Aitokallio-Tallberg A, Uotila J, Raudaskoski T, Ulander V-M et al (2010) Cesarean delivery in Finland: maternal complications and obstetric risk factors. Acta Obst Gyn Scand 89:896–902

    PubMed  Article  Google Scholar 

  9. Waterstone M, Bewley S, Wolfe C (2001) Incidence and predictors of severe obstetric morbidity. BMJ 322(7294):1089–1093

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  10. Farchi S, Polo A, Franco F, Di Lallo D, Guasticchi G (2010) Severe postpartum morbidity and mode of delivery: a retrospective cohort study. AOGS 89:1600–1603

    Article  Google Scholar 

  11. van Dillen J, Zwart J, Schutte J, van Roosmalen J (2010) Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis 23:249–254

    PubMed  Article  Google Scholar 

  12. Jarvie E, Ramsay JE (2010) Obstetric management of obesity in pregnancy. Seminars Fetal Neonatal Med 15:83–88

    Article  Google Scholar 

  13. Dinatale A, Ermito S, Fonti I, Giordano R, Cacciatore A, Romano M et al (2010) Obesity and fetal-maternal outcomes. J Prenatal Med 4(1):5–8

    Google Scholar 

  14. Acosta CD, Knight M, Lee HC, Kurinczuk JJ, Gould JB, Lyndon A (2013) The continuum of maternal sepsis severity: incidence and risk factors in a population-based cohort study. PLoS One 8(7):e67175

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  15. Fyfe EM, Thompson JM, Anderson NH, Groom KM, McCowan LM (2012) Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study. BMC Pregnancy Childbirth 12(1):112

    PubMed Central  PubMed  Article  Google Scholar 

  16. Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW et al (2001) Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 25(8):1175–1182

    CAS  PubMed  Article  Google Scholar 

  17. Kaisa Raatikainen, Nonna Heiskanen, Seppo Heinonen (2006) Transition from overweight to obesity worsens pregnancy outcome in a BMI-dependent manner. Obesity 14(1):165–171

    Article  Google Scholar 

  18. Acosta CD, Bhattacharya S, Tuffnell D, Kurinczuk JJ, Knight M (2012) Maternal sepsis: a Scottish population-based case control study. BJOG 119(4):474–483

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  19. Witteveen T, Zwart JJ, Gast KB, Bloemenkamp KW, van Roosmalen J (2013) Overweight and severe acute maternal morbidity in a low-risk pregnant population in the Netherlands. PLoS One 8(9):e74494

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  20. Samuelsson E, Hellgren M, Högberg U (2007) Pregnancy-related deaths to pulmonary embolism in Sweden. AOGS 86:435–443

    Article  Google Scholar 

  21. Temmerman M, Verstraelen H, Martens G, Bekaert A (2004) Delayed childbearing and maternal mortality. Eur J Obstet Gynecol Reprod Biol 114(1):19–22

    CAS  PubMed  Article  Google Scholar 

  22. Eskild A, Vatten LJ (2009) Abnormal bleeding associated with preeclampsia: a population study of 315,085 pregnancies. AOGS 88(2):154–158

    Article  Google Scholar 

  23. Riley LE, Tuomala RE, Heeren T, Greene MF (1996) Low risk of post-cesarean section infection in insulin-requiring diabetic women. Diabetes Care 19(6):597–600

    CAS  PubMed  Article  Google Scholar 

Download references

Conflict of interest

We declare that we have no conflict of interest.

Author information

Affiliations

  1. Department of Obstetrics and Gynaecology, Turku University Central Hospital, Kiinamyllynkatu 4-6, FI, 20520, Turku, Finland

    Nanneli Pallasmaa & Ulla Ekblad

  2. National Institute of Health and Welfare of Finland, Helsinki, Finland

    Mika Gissler

  3. Department of Obstetrics and Gynaecology, University of Turku, Turku, Finland

    Anna Alanen

Authors
  1. Nanneli Pallasmaa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ulla Ekblad
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mika Gissler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna Alanen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nanneli Pallasmaa.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Pallasmaa, N., Ekblad, U., Gissler, M. et al. The impact of maternal obesity, age, pre-eclampsia and insulin dependent diabetes on severe maternal morbidity by mode of delivery—a register-based cohort study. Arch Gynecol Obstet 291, 311–318 (2015). https://doi.org/10.1007/s00404-014-3352-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-014-3352-z

Keywords

  • Maternal morbidity
  • Delivery related
  • Cesarean section
  • Vaginal delivery
  • Mode of delivery