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Influence of gestational weight gain and BMI on cesarean delivery risk in adolescent pregnancies

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Obesity and excessive gestational weight gain (GWG) increase cesarean delivery (CD) risk; however, their influence on teen pregnancies is less clear. We describe the influence of GWG and pre-pregnancy body mass index (BMI) on primary CD (PCD) risk in adolescent compared with adult pregnancies.

Study Design:

Population-based cohort study of Ohio births (2006 to 2012), n=1 034 552. Analyses were limited to 251 398 singleton live births in term (37 to 42 weeks) primiparas. Multivariate logistic regression estimated the association between BMI, GWG and CD risk in teens compared with adults (20 to 34 years), adjusting for maternal race, smoking status and labor induction.


The primary cesarean rate (PCD) for primiparous women was 25.6%. It was lower for adolescents (17% <15 years, 17% 15 to 17 years, 19% 18 to 19 years) compared with adults (26%, P<0.001). The PCD rate increased with excessive (29%) vs Institute of Medicine (IOM)-recommended GWG (20%). The PCD rate was also increased in mothers who were overweight (29%), and obese (39%) vs those with normal pre-pregnancy BMI (20%, P<0.001). The lowest PCD rate (11.6%) observed in normal weight teens <18 years was with appropriate GWG (adjusted odds ratio (aOR) 0.61; 95% CI 0.54 to 0.69). Compared with adults, teens have 43% lower PCD risk (aOR 0.57; 95% CI 0.55 to 0.60). Excessive GWG increased the risk for PCD in adults by 64% (aOR 1.64; 95% CI 1.59 to 1.68). Excessive GWG increased PCD in the highest risk groups, obese adults (aOR 1.24; 1.17 to 1.32) and obese teens (aOR 1.26; 95% CI 1.08 to 1.46).


Excessive GWG increases the risk of PCD. Young maternal age was protective of this effect. However, excessive GWG increased PCD risk in both teen and adult mothers. To reduce the primary cesarean rate, efforts should target interventions to promote optimal GWG, especially in those at highest risk, obese women of all ages.

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  1. Koh H, Ee T, Malhotra R, Allen J, Tan T, Ostbye T . Predictors and adverse outcomes of inadequate or excessive gestational weight gain in an Asian population. J Obstet Gynaecol Res 2013; 39 (5): 905–913.

    Article  Google Scholar 

  2. Goncalves CV, Mendoza-Sassi RA, Cesar JA, de Castro NB, Bortolomedi AP . Body mass index and gestational weight gain as factors predicting complications and pregnancy outcome. Rev Bras Ginecol Obstet 2012; 34 (7): 304–309.

    Article  Google Scholar 

  3. Jang DG, Jo YS, Lee GS . Effect of pre-pregnancy body mass index and weight gain during pregnancy on the risk of emergency cesarean section in nullipara. Arch Gynecol Obstet 2011; 284 (6): 1389–1397.

    Article  Google Scholar 

  4. Langford A, Joshu C, Chang JJ, Myles T, Leet T . Does gestational weight gain affect the risk of adverse maternal and infant outcomes in overweight women. Matern Child Health J 2011; 15 (7): 860–865.

    Article  Google Scholar 

  5. Chang T, Choi HJ, Richardson C, Davis MM . Implications of teen birth for overweight and obesity in adulthood. Am J Obstet Gynecol 2013; 209 (2): 110.e1–110.e7.

    Article  Google Scholar 

  6. Groth S . The long-term impact of adolescent gestational weight gain. Res Nurs Health 2008; 31 (2): 108–118.

    Article  Google Scholar 

  7. Joseph NP, Hunkali KB, Wilson B, Morgan E, Cross M, Freund KM . Pre-pregnancy body mass index among pregnant adolescents: gestational weight gain and long-term postpartum weight retention. J Pediatr Adolesc Gynecol 2008; 21 (4): 195–200.

    Article  Google Scholar 

  8. Harper L, Chang JJ, Macones G . Adolescent pregnancy and gestational weight gain: do the Institute of Medicine recommendations apply? Am J Obstet Gynecol 2011; 205 (2): 140.e1–140.e8.

    Article  Google Scholar 

  9. Buschman NA, Foster G, Vickers P . Adolescent girls and their babies: achieving optimal birthweight. Gestational weight gain and pregnancy outcome in terms of gestation at delivery and infant birth weight: a comparison between adolescents under 16 and adult women. Child Care Health Dev 2001; 27 (2): 163–171.

    Article  CAS  Google Scholar 

  10. Sina H, Guichard I, Baker AM, Saddlemire S, Boggess KA . The effect of teenage maternal obesity on perinatal outcomes. Obstet Gynecol 2009; 113 (2): 300–304.

    Article  Google Scholar 

  11. Briggs MM, Hopman WM, Jamieson MA . Comparing pregnancy in adolescents and adults: obstetric outcomes and prevalence of anemia. J Obstet Gynaecol Can 2007; 29 (7): 546–555.

    Article  Google Scholar 

  12. Howie L, Parker J, Schoendorf . Excessive maternal weight gain patterns in adolescents. J Am Diet Assoc 2003; 103 (12): 1653–1657.

    Article  Google Scholar 

  13. Johnson J, Clifton RG, Roberts JM, Myatt L, Hauth JC, Spong CY et al. Pregnancy outcomes with weight gain above or below the 2009 Institute of Medicine guidelines. Obstet Gynecol 2013; 121 (5): 969–975.

    Article  Google Scholar 

  14. Magriples U, Kershaw TS, Rising SS, Westdahl C, Ickovics JR . The effects of obesity and weight gain in young women on obstetric outcomes. Am J Perinatol 2009; 26 (5): 365–371.

    Article  Google Scholar 

  15. Haeri S, Masouem S, Baker A, Saddlemire S, Boggess KA . The effect of excess weight gain in teenage pregnancies. Am J Perinat 2010; 27 (1): 15–18.

    Article  Google Scholar 

  16. National Center for Health Statistics. 2003 Revisions of the U.S. Standard Certificates of Live Birth. Hyattsville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved August 2015 from

  17. National Center for Health Statistics (2012). Guide to Completing the Facility Worksheets for the Certificate of Live Birth and Report of Fetal Death (2003 revision). Hyattsville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved August 2015 from

  18. Kathleen R, Yaktine AL . Weight Gain During Pregnancy: Reexamining the Guidelines. Institute of Medicine and National Research Council: Washington, DC, 2009.

    Google Scholar 

  19. de Onis M, Habicht JP . Anthropometric reference data for international use: recommendations from a World Health Organization Expert Committee. Am J Clin Nutr 1996; 64 (4): 650–658.

    Article  CAS  Google Scholar 

  20. de Onis M, Lobstein T . Defining obesity risk status in the general childhood population: which cut-offs should we use? Int J Pediatr Obes 2010; 5 (6): 458–460.

    Article  CAS  Google Scholar 

  21. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R et al. CDC growth charts: United States. Adv Data 2000; 11: 1–27.

    Google Scholar 

  22. Elchert J, Beaudrot M, DeFranco E . Gestational weight gain in adolescent compared with adult pregnancies: an age-specific body mass index approach. J Pediatrics 2015; 167: 579–85.

    Article  Google Scholar 

  23. Mamun AA, Kinarivala M, O'Callaghan MJ, Williams GM, Najman JM, Callaway LK et al. Associations of excess weight gain during pregnancy with long-term maternal overweight and obesity: evidence from 21 year postpartum follow up. Am J Clin Nutr 2010; 91 (5): 1336–1341.

    Article  CAS  Google Scholar 

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We thank Eric Hall, PhD, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, for his assistance with figure preparation. Funding for this work was provided by an educational grant from the University of Cincinnati Department of Obstetrics and Gynecology Women's Health Scholars Program and the Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; March of Dimes Grant 22-FY14-470.

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Correspondence to E A DeFranco.

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The authors declare no conflict of interest.

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The abstract for this study was presented as an oral presentation at the Annual Meeting of the American College of Obstetricians and Gynecologists (ACOG), 2–6 May 2015 in San Francisco, CA, USA.


This study includes data provided by the Ohio Department of Health which should not be considered an endorsement of this study or its conclusions.

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Beaudrot, M., Elchert, J. & DeFranco, E. Influence of gestational weight gain and BMI on cesarean delivery risk in adolescent pregnancies. J Perinatol 36, 612–617 (2016).

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