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Population-Based Assessment of the Risk of Primary Cesarean Delivery Due to Excess Prepregnancy Weight Among Nulliparous Women Delivering Term Infants

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Objective: To estimate the risk of cesarean delivery due to excess prepregnancy body mass index (BMI) in a multistate, US population-based sample. Methods: We analyzed data from the population-based Pregnancy Risk Assessment Monitoring System (PRAMS) on 24,423 nulliparous women with single, term infants delivered between 1998 and 2000 in 19 states. We calculated BMI from self-reported weight and height. We assessed interactions between prepregnancy BMI and other risk factors. We estimated weighted relative risks and 95% confidence intervals for the association between prepregnancy BMI and cesarean section from multiple logistic regression models adjusting for demographic and medical risk factors from the PRAMS questionnaire or birth certificates. Results: The incidence of cesarean delivery increased with increased prepregnancy BMI, from 14.3% (0.8 standard error (SE)) for lean women (BMI < 19.8) to 42.6% (2.0 SE) for very obese women (BMI ≥ 35). The risk of cesarean section differed by presence of any medical, labor and/or delivery complication. Among women with any complication, the estimated adjusted RR for cesarean delivery was 1.1 (95% confidence interval (CI) 1.0–1.2) among overweight women, 1.3 (95% CI 1.1–1.4) among obese women, and 1.4 (95% CI 1.2–1.6) among very obese women compared with normal weight women. Among women without any complications, the estimated adjusted RR was 1.4 (95% CI 1.0–1.8) among overweight women, 1.5 (95% CI 1.1–2.1) among obese women, and 3.1 (95% CI 2.3–4.8) among very obese women. Conclusion: Excess prepregnancy weight increases the risk of cesarean delivery among nulliparous women giving birth to single, term infants, especially among very obese women without any complications.

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REFERENCES

  1. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: Final Data for 2002. National Vital Statistics Reports. Hyattsville, MD: National Center for Health Statistics, 2003, Vol. 52, No. 10.

  2. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002;288:1723–1727.

    Article  PubMed  Google Scholar 

  3. Kaiser PS, Kirby RS. Obesity as a risk factor for cesarean in a low-risk population. Obstet Gynecol 2001;97:39–43.

    Article  PubMed  CAS  Google Scholar 

  4. Young TK, Woodmansee B. Factors that are associated with cesarean delivery in a large private practice: The importance of prepregnancy body mass index and weight gain. Am J Obstet Gynecol 2002;187:312–320.

    Article  PubMed  Google Scholar 

  5. Jensen DM, Damm P, Sorensen B, Molsted-Pedersen L, Westergaard JG, Ovesen P, et al. Pregnancy outcome and prepregnancy body mass index in 2459 glucose-tolerant Danish women. Am J Obstet Gynecol 2003;189:239–244.

    Article  PubMed  Google Scholar 

  6. Witter FR, Caufield LE, Stoltzfus RJ. Influence of maternal anthropometric status and birth weight on the risk of cesarean delivery. Obstet Gynecol 1995;85:947–951.

    Article  PubMed  CAS  Google Scholar 

  7. Brost BC, Goldenberg RL, Mercer BM, Iams JD, Meis PJ, Moawad AH, et al. The Preterm Prediction Study: Association of cesarean section with increases in maternal weight and body mass index. Am J Obstet Gynecol 1997;177:333–341.

    Article  PubMed  CAS  Google Scholar 

  8. Cnattingius R, Cnattinggius S, Notzon FC. Obstacles to reducing cesarean rates in a low-cesarean setting: The effect of maternal age, height, and weight. Obstet Gynecol 1998;92:501–506.

    Article  PubMed  CAS  Google Scholar 

  9. Crane SS, Wojtowycz MA, Dye TD, Aubry RH, Artal R. Association between prepregnancy obesity and the risk of cesarean delivery. Obstet Gynecol 1997;89:213–216.

    Article  PubMed  CAS  Google Scholar 

  10. Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004;103:219–224.

    PubMed  Google Scholar 

  11. Perlow JH, Morgan MA. Massive maternal obesity and perioperative cesarean morbidity. Am J Obstet Gynecol 1994;170:560–565.

    PubMed  CAS  Google Scholar 

  12. Bianco AT, Smilen SW, Davis Y, Lopez A, Lapinski R, Lockwood CJ. Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol 1998;91:97–102.

    Article  PubMed  CAS  Google Scholar 

  13. Nuthalapaty FS, Rouse DJ, Owen J. The association of maternal weight with cesarean risk, labor duration, and cervical dilation rate during labor induction. Obstet Gynecol 2004;103:452–456.

    PubMed  Google Scholar 

  14. Buhimschi CS, Buhimschi I, Malinow AM, Weiner CP. Intrauterine pressure during the second stage of labor in obese women. Obstet Gynecol 2004;103:225–230.

    PubMed  Google Scholar 

  15. Institute of Medicine. Nutrition during pregnancy. Part I, Weight Gain. Washington, DC: National Academy Press, 1990.

    Google Scholar 

  16. SUDAAN, Release 8.0 [Computer Software], Research, Triangle Park (NC): Research Triangle Institute, 1991.

  17. Hosmer DW, Lemeshow S. Applied Logistic Regression, New York, NY: Wiley, 1989.

    Google Scholar 

  18. Zhang J, Yu KF. What's the relative risk? A method for correcting the odds ratio in cohort studies of common outcomes. JAMA 1998;280:1690–1691.

    Article  PubMed  CAS  Google Scholar 

  19. Efron B, Tibshirani R. An Introduction to the Bootstrap. New York, NY: Chapman & Hall, 1993.

    Google Scholar 

  20. Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park M. Births: Final Data for 2000. National Vital Statistics Reports. Hyattsville, MD: National Center for Health Statistics, 2002, Vol. 50, No. 5.

  21. Lederman SA, Paxton A. Maternal reporting of prepregnancy weight and birth outcome: Consistency and completeness compared with the clinical record. Matern Child Health J 1998;2(2):123–126.

    Article  PubMed  CAS  Google Scholar 

  22. Stevens-Simon C, Roghmann KJ, McAnarney ER. Relationship of self-reported prepregnant weight and weight gain during pregnancy to maternal body habitus and age. J Am Diet Assoc 1992;92:85–87.

    PubMed  CAS  Google Scholar 

  23. DiGiuseppe DL, Aron DC, Random L, Harper DL, Rosenthal GE. Reliability of birth certificate data: A multi-hospital comparison to medical records information. Matern Child Health J 2002;6(3):169–179.

    Article  PubMed  Google Scholar 

  24. Dobie SA, Baldwin L, Rosenblatt RA, Fordyce MA, Andrilla CH, Hart LG. How well do birth certificates describe the pregnancies they report? The Washington State experience with low-risk pregnancies. Matern Child Health J 1998;2:145–154.

    Article  PubMed  CAS  Google Scholar 

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ACKNOWLEDGMENTS

Data from the Pregnancy Risk Assessment Monitoring System (PRAMS) included in this study are collected at the state level by the following state collaborators and their staff: Alabama-Rhonda Stephens, MPH; Alaska-Kathy Perham-Hester, MS, MPH; Arkansas-Gina Redford, MAP; Colorado-Alyson Shupe, PhD; Florida-Helen Marshall; Hawaii-Limin Song, MPH, CHES; Illinois-Theresa Sandidge, MA; Louisiana-Dionka Pierce; Maine-Martha Henson; Nebraska-Jennifer Severe-Oforah, PhD; New Mexico-Ssu Weng, MD, MPH; New York State-Anne Radigan-Garcia; North Carolina-Paul Buescher, PhD; Ohio-Amy Davis; Oklahoma-Dick Lorenz, MS; South Carolina-Mary Kate Powell; Utah-Lois Bloebaum; Washington-Linda Lohdefinck; West Virginia-Melissa Baker, MA; CDC PRAMS Team, Applied Sciences Branch, Division of Reproductive Health.

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Authors and Affiliations

  1. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Promotion, Atlanta, Georgia

    Patricia M. Dietz DrPH, William M. Callaghan MD, MPH, Brian Morrow MA & Mary E. Cogswell DrPH

  2. Centers for Disease Control and Promotion, MS K-23, 4770 Buford Highway, NE, Atlanta, Georgia, 30341-3714

    Patricia M. Dietz DrPH

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  1. Patricia M. Dietz DrPH
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  2. William M. Callaghan MD, MPH
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  3. Brian Morrow MA
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  4. Mary E. Cogswell DrPH
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Correspondence to Patricia M. Dietz DrPH.

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Dietz, P.M., Callaghan, W.M., Morrow, B. et al. Population-Based Assessment of the Risk of Primary Cesarean Delivery Due to Excess Prepregnancy Weight Among Nulliparous Women Delivering Term Infants. Matern Child Health J 9, 237–244 (2005). https://doi.org/10.1007/s10995-005-0003-9

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  • DOI: https://doi.org/10.1007/s10995-005-0003-9

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