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Medical/Surgical/Diseases/Complications

Poster Session 4

(1045) The dose-dependent effect of obesity on maternal and neonatal outcomes

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To evaluate the prevalence of adverse maternal and neonatal outcomes associated with obesity. We hypothesized that obesity confers a dose-dependent risk for these outcomes.

Study Design: This was a retrospective cohort study of singleton pregnancies delivered between 24 and 42 weeks gestation at an urban county hospital between 2013 and 2021. Body mass index (BMI) at first prenatal visit was used as a proxy for pre-pregnancy weight. Patients were excluded if no first trimester BMI was available.

Results: During the study period, 58497 patients delivered a singleton infant, of which 12365 (21.1%), 5429 (9.3%), and 3482 (6.0%) had class I, II, and III obesity, respectively. Non-obese patients were more likely to be younger and nulliparous with a mean delivery gestational age of 39 weeks across all groups. Increasing obesity was associated with a dose-dependent increase in cesareans (27% for non-obese versus 46% for class III obesity). There was an association between increasing obesity and peripartum complications, including severe preeclampsia (8% in non-obese versus 19% in class III obesity) and gestational diabetes (5% in non-obese versus 15% in class III obesity). Infants born to patients with class III obesity versus non-obese patients were more likely to develop grade III-IV intraventricular hemorrhage (RR 4.58, 95%, CI 2.10-9.99), sepsis (RR 3.76, 95% CI 2.00-7.06), respiratory distress syndrome (RDS) (RR 2.66, 95% CI 2.15-3.29), and have an initial cord gas pH < 7 (RR 2.48, 95%CI 1.68-3.66) (Figure). 

Conclusion: Increasing BMI is associated with a dose-dependent increase in associated adverse maternal and neonatal outcomes. Infants born to patients with higher classes of obesity have significant associated morbidity including a 2 to 4 times increased risk of neonatal acidosis, grades III-IV IVH, sepsis, and RDS.