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Sheikh I, Fuller KA, Addae-Konadu K, Dotters-Katz SK, Varvoutis MS. The Impact of Body Mass Index on Postpartum Infectious Morbidities and Wound Complications: A Study of Extremes. Am J Perinatol 2024; 41:349-354. [PMID: 34710942 DOI: 10.1055/a-1682-2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE As body mass index increases, the risk of postpartum infections has been shown to increase. However, most studies lump women with a body mass index (BMI) of above 40 kg/m2 together, making risk assessment for women in higher BMI categories challenging. The objective of this study was to evaluate the impact of extreme obesity on postpartum infectious morbidity and wound complications during the postpartum period. STUDY DESIGN The present study is a secondary analysis of women who underwent cesarean delivery and had BMI ≥ 40 kg/m2 in the Maternal-Fetal Medicine Units Cesarean Registry. The primary outcome was a composite of postpartum infectious morbidity including endometritis, wound infection, inpatient wound complication prior to discharge, and readmission due to wound complications. Appropriate statistics used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40-49.9, 50-59.9, 60-69.9, and >70 kg/m2). RESULTS Rates of postpartum infectious morbidity increased with BMI category (11.7% BMI: 50-59.9 kg/m2; 13.7% BMI: 60-69.9 kg/m2; and 21.9% BMI >70+ kg/m2; p = 0.001). Readmission for wound complications also increased with BMI (3.1% for BMI: 50-59.9 kg/m2; 6.2% for BMI: 60-69.9 kg/m2; and 9.4% for BMI >70+ kg/m2; p = 0.001). After adjusting for confounders, increased BMI of 70+ kg/m2 category remained the most significant predictor of postpartum infectious complications compared with women with BMI of 40 to 49.9 kg/m2 (adjusted odds ratio [aOR] = 6.38; 95% confidence interval [CI]: 1.37-29.7). The adjusted odds of readmission also increased with BMI (aOR = 2.33, 95% CI: 1.35-4.02 for BMI 50-59.9 kg/m2; aOR = 4.91, 95% CI: 2.07-11.7 for BMI of 60-69.9 kg/m2; and aOR = 36.2, 95% CI: 7.45-176 for BMI >70 kg/m2). CONCLUSION Women with BMI 50 to 70+ kg/m2 are at an increased risk of postpartum wound infections and complications compared with women with BMI 40 to 49.9 kg/m2. These data provide increased guidance for counseling women with an extremely elevated BMI and highlight the importance of postpartum wound prevention bundles. KEY POINTS · Women with super obesity have higher rates of wound complications.. · Women at extremes of obesity experience worse postpartum infectious morbidity.. · More research is needed on effective strategies to minimize morbidity in this population..
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Affiliation(s)
- Iqra Sheikh
- Department of Obstetrics and Gynecology, West Virginia University, Morgantown, West Virginia
| | - Kylie A Fuller
- Department of Obstetrics and Gynecology, West Virginia University, Morgantown, West Virginia
| | | | | | - Megan S Varvoutis
- Department of Obstetrics and Gynecology, West Virginia University, Morgantown, West Virginia
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Bretón I, Ballesteros-Pomar MD, Calle-Pascual A, Alvarez-Sala LA, Rubio-Herrera MA. Micronutrients in Pregnancy after Bariatric Surgery: A Narrative Review. J Clin Med 2023; 12:5429. [PMID: 37629473 PMCID: PMC10455502 DOI: 10.3390/jcm12165429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Bariatric surgery is increasingly used in women of childbearing age due to the rising prevalence of obesity and the effectiveness and availability of this treatment. Pregnancy in women with previous bariatric surgery deserves special attention. Weight loss induced by surgery reduces the risks that obesity poses to pregnancy. But on the other hand, decreased intake and malabsorption may increase the risk of malnutrition and micronutrient deficiency and negatively affect maternal and foetal health. The aim of this narrative review is to provide an updated analysis of the impact of different bariatric surgery techniques on mineral and micronutrient nutritional status during pregnancy and the possible effect on maternal-foetal health.
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Affiliation(s)
- Irene Bretón
- Department of Endocrinology and Nutrition, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
| | - María D. Ballesteros-Pomar
- Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, 24008 León, Spain
| | - Alfonso Calle-Pascual
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Luis Antonio Alvarez-Sala
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Miguel Angel Rubio-Herrera
- Department of Medicine, Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, 28040 Madrid, Spain
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Olerich K, Soper D, Delaney S, Sterrett M. Pregnancy Care for Patients With Super Morbid Obesity. Front Pediatr 2022; 10:839377. [PMID: 35928678 PMCID: PMC9343711 DOI: 10.3389/fped.2022.839377] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
The patient with obesity represents unique challenges to the medical community and, in the setting of pregnancy, additional risks to both mother and fetus. This document will focus on the risks and considerations needed to care for the women with obesity and her fetus during the antepartum, intrapartum, and immediate postpartum stages of pregnancy. Specific attention will be given to pregnancy in the setting of class III and super morbid obesity.
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Affiliation(s)
- Kelsey Olerich
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - David Soper
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, United States
| | - Shani Delaney
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Mary Sterrett
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States.,Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, United States
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Arai T, Tanabe S, Honda I, Kohyama A. Super-obese pregnancy - understanding the difference from a normal pregnancy and using early multidisciplinary intervention can lead to good outcomes: a case report. HYPERTENSION RESEARCH IN PREGNANCY 2021. [DOI: 10.14390/jsshp.hrp2021-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Serabi Tanabe
- Department of Anesthesiology, Tokyo Metropolitan Tama Medical Center
| | - Izumi Honda
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center
| | - Akira Kohyama
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center
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Bracken O, Langhe R. Evaluation of maternal and perinatal outcomes in pregnancy with high BMI. Ir J Med Sci 2021; 190:1439-1444. [PMID: 33428089 DOI: 10.1007/s11845-020-02456-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 12/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Maternal obesity is a significant risk factor for unfavourable outcomes during pregnancy. However, the extent of this relationship is poorly defined in Irish mothers. AIMS This study was to compare maternal and perinatal outcomes between obese and non-obese mothers in an Irish population. METHODS A retrospective comparative study was conducted in a secondary level maternity unit for births recorded between January 2018 and January 2019 and 2,793 women were included. BMI calculated at booking visit was used to compare obese (BMI ≥ 30 kg/m2) and non-obese mothers (BMI < 30 kg/m2). RESULTS Of 2,793 women included in this study, 2111 had a BMI < 30 kg/m2 and 682 had a BMI ≥ 30 kg/m2. Obese women were less likely to experience spontaneous onset of labour (33.4% vs. 48.1%, p < 0.001) and more likely to be induced (37.2% vs. 31.0%, p = 0.002). Obesity was associated with a statistically significant increase in stillbirth, fetal macrosomia and emergency caesarean birth rates, whereas operative vaginal deliveries were significantly decreased. Miscarriage, shoulder dystocia, post-partum haemorrhage and spontaneous vaginal deliveries were reduced while elective caesarean birth and low birth weight incidence were increased in obese mothers; however, these results were not statistically significant. CONCLUSIONS This study highlights the magnitude of obstetric risks that are associated with maternal obesity within Irish population. Implementation of effective intervention strategies to reduce the number of obese women in pregnancy may have beneficial effects on pregnancy outcomes in Ireland.
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Affiliation(s)
- Orla Bracken
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ream Langhe
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Pushing the Envelope in Obstetric Care: A Case Report of Cesarean Delivery in a Parturient with a BMI >100 kg m -2. Case Rep Anesthesiol 2020; 2020:5498584. [PMID: 32685215 PMCID: PMC7341382 DOI: 10.1155/2020/5498584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/01/2020] [Accepted: 05/12/2020] [Indexed: 02/02/2023] Open
Abstract
An increasing number of women with a body mass index (BMI) ≥ 60 kg m−2, referred to as super-super obesity, are requiring anesthetic care for labor and delivery. Management of these patients presents obstetric, anesthetic, and logistical challenges. We report our experience in the management of cesarean delivery in a parturient with a BMI of 112 kg m−2. Use of epidural anesthesia and performance of a supraumbilical transverse surgical incision with caudal placement of the panniculus resulted in optimal hemodynamic and ventilatory parameters. Effective multidisciplinary planning and communication is key. We present this case to highlight decision-making strategies and elucidate our approach in the management of this complex obstetric case.
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Abstract
Although there is much discussion about population health in academic medical centers, managed care organizations, and a variety of disciplines, it is not always clear what this term means. Population health describes the health outcomes of a group of individuals including health disparities, social determinants of health, and policies and interventions that link health outcomes with and patterns of health determinants. We describe some of the successes and challenges to addressing reproductive health issues in Georgia from a population health perspective, focusing on efforts to reduce teenage pregnancy and improve maternal health.
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Maternal and perinatal outcomes in pregnant women with BMI >50: An international collaborative study. PLoS One 2019; 14:e0211278. [PMID: 30716114 PMCID: PMC6361432 DOI: 10.1371/journal.pone.0211278] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/10/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine the association between maternal BMI>50kg/m2 during pregnancy and maternal and perinatal outcomes. MATERIALS AND METHODS An international cohort study was conducted using data from separate national studies in the UK and Australia. Outcomes of pregnant women with BMI>50 were compared to those of pregnant women with BMI<50. Multivariable logistic regression estimated the association between BMI>50 and perinatal and maternal outcomes. RESULTS 932 pregnant women with BMI>50 were compared with 1232 pregnant women with BMI<50. Pregnant women with BMI>50 were slightly older, more likely to be multiparous, and have pre-existing comorbidities. There were no maternal deaths, however, extremely obese women had a nine-fold increase in the odds of thrombotic events compared to those with a BMI<50 (uOR: 9.39 (95%CI:1.15-76.43)). After adjustment, a BMI>50 during pregnancy had significantly raised odds of preeclampsia/eclampsia (aOR:4.88(95%CI: 3.11-7.65)), caesarean delivery (aOR: 2.77 (95%CI: 2.31-3.32)), induction of labour (aOR: 2.45(95% CI:2.00-2.99)) post caesarean wound infection (aOR:7.25(95%CI: 3.28-16.07)), macrosomia (aOR: 8.05(95%CI: 4.70-13.78)) compared a BMI<50. Twelve of the infants born to women in the extremely obese cohort died in the early neonatal period or were stillborn. CONCLUSIONS Pregnant women with BMI>50 have a high risk of inferior maternal and perinatal outcomes.
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McCall SJ, Li Z, Kurinczuk JJ, Sullivan E, Knight M. Binational cohort study comparing the management and outcomes of pregnant women with a BMI >50-59.9 kg/m 2 and those with a BMI ≥60 kg/m 2. BMJ Open 2018; 8:e021055. [PMID: 30099391 PMCID: PMC6089316 DOI: 10.1136/bmjopen-2017-021055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To compare the management, maternal and perinatal outcomes of women with a body mass index (BMI) ≥60 kg/m2 with women with a BMI >50-59.9 kg/m2. DESIGN International collaborative cohort study. SETTING Binational study in the UK and Australia. PARTICIPANTS UK: all pregnant women, and Australia: women who gave birth (birth weight ≥400 g or gestation ≥20 weeks) METHODS: Data from the Australasian Maternity Outcomes Surveillance System and UK Obstetric Surveillance System. Management, maternal and infant outcomes were compared between women with a BMI ≥60 kg/m2 and women with a BMI >50-59.9 kg/m2, using unconditional logistic regression. RESULTS The sociodemographic characteristics and previous medical histories were similar between the 111 women with a BMI ≥60 kg/m2 and the 821 women with a BMI >50-59.9 kg/m2. Women with a BMI ≥60 kg/m2 had higher odds of thromboprophylaxis usage in both the antenatal (24% vs. 12%; OR 2.25, 95% CI 1.39 to 3.64) and postpartum periods (78% vs. 66%; OR 1.68, 95% CI 1.04 to 2.70). Women with BMI ≥60 kg/m2 had nearly double the odds of pre-eclampsia/eclampsia (adjusted OR 1.83 (95% CI 1.01 to 3.30)). No other maternal or perinatal outcomes were statistically significantly different. Severe adverse outcomes such as perinatal death were uncommon in both groups thus limiting the power of these comparisons. The rate of perinatal deaths was 18 per 1000 births for those with BMI ≥60 kg/m2; 12 per 1000 births for those with BMI >50-59.9 kg/m2; those with BMI ≥60 kg/m2 had a non-significant increased odds of perinatal death (unadjusted OR 1.46, 95% CI 0.31 to 6.74). CONCLUSIONS Women are managed differently on the basis of BMI even at this extreme as shown by thromboprophylaxis. The pre-eclampsia result suggests that future research should examine whether weight reduction of any amount prior to pregnancy could reduce poor outcomes even if women remain extremely obese.
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Affiliation(s)
- Stephen J McCall
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhuoyang Li
- The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, Australia
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elizabeth Sullivan
- The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, Australia
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Macrosomia. A Systematic Review of Recent Literature. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background and aims: The obesity and overweight rate among women of childbearing age and fetal macrosomia associated with different birth injuries are very frequent all over the world and with an increasing incidence. The huge amount of published literature on this topic in the last decade is putting the practioners in a very challenging position. Material and method: We have done a systematic review on the recent literature (last five years) based on science direct database. Results: A total of 5990 articles were identified and after successive exclusion of some of them, 48 were deeply analyzed. The results were grouped in following topics: risk factors for fetal macrosomia, the pathophysiology of macrosomia, prenatal clinical and lab diagnosis and prevention of macrosomia. Conclusions: Considering the maternal, fetal and neonatal complications of macrosomia, the counseling, and monitoring of the pregnant women risk group are of particular importance for adopting a low calorie / low glycemic diet and avoiding a sedentary behaviour. Long-term follow-up of the mother and the macrosomic baby is required because of the risk of obesity, diabetes, hypertension, and metabolic syndrome later in life.
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Body Mass Index 50 kg/m2 and Beyond: Perioperative Care of Pregnant Women With Superobesity Undergoing Cesarean Delivery. Obstet Gynecol Surv 2017; 72:500-510. [DOI: 10.1097/ogx.0000000000000469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Garner CD, McKenzie SA, Devine CM, Thornburg LL, Rasmussen KM. Obese women experience multiple challenges with breastfeeding that are either unique or exacerbated by their obesity: discoveries from a longitudinal, qualitative study. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27452978 DOI: 10.1111/mcn.12344] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 12/01/2022]
Abstract
Obese women are at risk for shorter breastfeeding duration, but little is known about how obese women experience breastfeeding. The aim of this study was to understand obese women's breastfeeding experiences. We enrolled pregnant women in upstate New York, who were either obese [n = 13; body mass index (BMI) ≥30 kg/m2 ] or normal weight (n = 9; BMI 18.5-24.9 kg/m2 ) before conception and intended to breastfeed. A longitudinal, qualitative study was conducted from February 2013 through August 2014 with semi-structured interviews during pregnancy and at specific times post-partum through 3 months. Interviews were audio recorded, transcribed and analyzed using content analysis. Themes that emerged in analysis were compared between obese and normal-weight women. Differences were identified and described. Prenatally, obese women expressed less confidence about breastfeeding than normal-weight women. Post-partum, obese women and their infants had more health issues that affected breastfeeding, such as low infant blood glucose. Compared with normal-weight women, they also experienced more challenges with latching and positioning their infants. Breastfeeding required more time, props and pillows, which limited where obese women could breastfeed. Obese women also experienced more difficulty finding nursing bras and required more tangible social support than normal-weight women. In conclusion, obese women experienced more challenges than women of normal weight; some challenges were similar to those of normal-weight women but were experienced to a greater degree or a longer duration. Other challenges were unique. Obese women could benefit from targeted care prenatally and during the hospital stay as well as continued support post-partum to improve breastfeeding outcomes. © 2016 John Wiley & Sons Ltd.
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Affiliation(s)
| | | | - Carol M Devine
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Loralei L Thornburg
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA
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Krishna I, Badell M, Loucks TL, Lindsay M, Samuel A. Adverse perinatal outcomes are more frequent in pregnancies with a low fetal fraction result on noninvasive prenatal testing. Prenat Diagn 2016; 36:210-5. [DOI: 10.1002/pd.4779] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Iris Krishna
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine; Emory University School of Medicine; Atlanta GA USA
| | - Martina Badell
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine; Emory University School of Medicine; Atlanta GA USA
| | - Tammy L. Loucks
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine; Emory University School of Medicine; Atlanta GA USA
| | - Michael Lindsay
- Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine; Emory University School of Medicine; Atlanta GA USA
| | - Amber Samuel
- Maternal-Fetal Medicine; Obstetrix Medical Group of Houston; The Woodlands TX USA
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Sullivan EA, Dickinson JE, Vaughan GA, Peek MJ, Ellwood D, Homer CSE, Knight M, McLintock C, Wang A, Pollock W, Jackson Pulver L, Li Z, Javid N, Denney-Wilson E, Callaway L. Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study. BMC Pregnancy Childbirth 2015; 15:322. [PMID: 26628074 PMCID: PMC4667490 DOI: 10.1186/s12884-015-0693-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 10/05/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Super-obesity is associated with significantly elevated rates of obstetric complications, adverse perinatal outcomes and interventions. The purpose of this study was to determine the prevalence, risk factors, management and perinatal outcomes of super-obese women giving birth in Australia. METHODS A national population-based cohort study. Super-obese pregnant women (body mass index (BMI) >50 kg/m(2) or weight >140 kg) who gave birth between January 1 and October 31, 2010 and a comparison cohort were identified using the Australasian Maternity Outcomes Surveillance System (AMOSS). Outcomes included maternal and perinatal morbidity and mortality. Prevalence estimates calculated with 95% confidence intervals (CIs). Adjusted odds ratios (ORs) were calculated using multivariable logistic regression. RESULTS 370 super-obese women with a median BMI of 52.8 kg/m(2) (range 40.9-79.9 kg/m(2)) and prevalence of 2.1 per 1 000 women giving birth (95% CI: 1.96-2.40). Super-obese women were significantly more likely to be public patients (96.2%), smoke (23.8%) and be socio-economically disadvantaged (36.2%). Compared with other women, super-obese women had a significantly higher risk for obstetric (adjusted odds ratio (AOR) 2.42, 95% CI: 1.77-3.29) and medical (AOR: 2.89, 95% CI: 2.64-4.11) complications during pregnancy, birth by caesarean section (51.6%) and admission to special care (HDU/ICU) (6.2%). The 372 babies born to 365 super-obese women with outcomes known had significantly higher rates of birthweight ≥ 4500 g (AOR 19.94, 95 % CI: 6.81-58.36), hospital transfer (AOR 3.81, 95 % CI: 1.93-7.55) and admission to Neonatal Intensive Care Unit (NICU) (AOR 1.83, 95% CI: 1.27-2.65) compared to babies of the comparison group, but not prematurity (10.5% versus 9.2%) or perinatal mortality (11.0 (95% CI: 4.3-28.0) versus 6.6 (95% CI: 2.6- 16.8) per 1 000 singleton births). CONCLUSIONS Super-obesity in pregnancy in Australia is associated with increased rates of pregnancy and birth complications, and with social disadvantage. There is an urgent need to further address risk factors leading to super-obesity among pregnant women and for maternity services to better address pre-pregnancy and pregnancy care to reduce associated inequalities in perinatal outcomes.
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Affiliation(s)
- Elizabeth A Sullivan
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
- School of Women's and Children's Health, The University of New South Wales, Sydney, Australia.
| | - Jan E Dickinson
- School of Women's and Infants' Health, The University of Western Australia, Perth, Australia.
| | - Geraldine A Vaughan
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Michael J Peek
- Department of Obstetrics and Gynaecology Medical School College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia.
- Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Canberra, Australia.
| | - David Ellwood
- School of Medicine, Griffith University, Queensland, Australia.
- Gold Coast University Hospital, Queensland, Australia.
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
| | - Claire McLintock
- Obstetrics and Gynaecology, National Women's Health, Auckland City Hospital, Auckland, New Zealand.
| | - Alex Wang
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Wendy Pollock
- Judith Lumley Centre, La Trobe University, Melbourne, Australia.
- Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Lisa Jackson Pulver
- Muru Marri Indigenous Health Unit, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia.
| | - Zhuoyang Li
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Nasrin Javid
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Elizabeth Denney-Wilson
- Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia.
| | - Leonie Callaway
- Royal Brisbane and Women's Hospital, Brisbane, Australia.
- School of Medicine, The University of Queensland, Brisbane, Australia.
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Garner CD, Ratcliff SL, Devine CM, Thornburg LL, Rasmussen KM. Health professionals' experiences providing breastfeeding-related care for obese women. Breastfeed Med 2014; 9:503-9. [PMID: 25347705 PMCID: PMC4267547 DOI: 10.1089/bfm.2014.0104] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Obese women are at high risk of early breastfeeding cessation, and health professionals (HPs) have a unique opportunity to provide them with breastfeeding support. Our objective was to describe HPs' experiences providing breastfeeding care for obese women during the prenatal, peripartum, and postpartum periods. MATERIALS AND METHODS In-depth, qualitative interviews were conducted with 34 HPs (including obstetricians, midwives, pediatricians, nurses, and lactation consultants) who care for pregnant or lactating women. They were recruited from a variety of settings in central New York. Interviews were audio-recorded, transcribed, verified for accuracy, and then analyzed qualitatively. RESULTS HPs identified obesity in multiple ways, some of which were consistent with standard cutoffs, whereas others implied extreme obesity. Nearly all HPs discussed ways they perceive obese women have challenges with breastfeeding. Some HPs described challenges as specific to obese women (e.g., limited mobility), whereas others described challenges as universal but more likely to occur among obese women (e.g., difficulties positioning the infant to breastfeed). Across professions, HPs described providing breastfeeding care for obese women as requiring more time and physical work and as being more challenging. HPs acknowledged stigma around obesity and discussed treating obese women with dignity and the same as other women. Strategies were suggested for improving breastfeeding support for obese women. CONCLUSIONS HPs identified multiple challenges that obese women encounter with breastfeeding, as well as their own challenges with providing care. Comprehensive strategies are needed to assist obese women with breastfeeding and to alleviate strain on HPs who provide their care.
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Affiliation(s)
| | | | - Carol M. Devine
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Loralei L. Thornburg
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York
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