Adverse Pregnancy Outcomes Among Obese Women

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Adverse Pregnancy Outcomes Among Obese Women

• Utah PRAMS 2000 2002
• Laurie Baksh, MPH, Joanne Barley, BS,
• Lois Bloebaum, MPA BSN, Nan Streeter, MS RN,
• Debbie Carapezza, MSN RN, Phyllis Crowley, MS RD,
  
• Karen Nellist, MPH
• Utah Department of Health

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Trends in Obesity

• Adult Americans are becoming increasingly
  overweight.
• Rates of prepregnancy obesity have increased over
  40 in the last decade in Utah.

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Prepregnancy Obesity in Utah1994 - 2004
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Obesity Rates Among Reproductive Aged Women
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Literature

• Current literature indicates that obese women are
  at increased risk for
• Hormonal Contraceptive Failure
• Antepartum stillbirth
• Diabetes
• Hypertension
• Macrosomia
• Inadequate labor patterns
• Cesarean Section
• Fraternal Twins
• Birth Defects

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BMI

• Body Mass Index (BMI) is a measure of body fat
  based upon height and weight an applies to both
  men and women.
• BMI is calculated as follows
• (weight in pounds/height in inches2) X 703

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BMI

• Four categories
• Underweight lt 18.5
• Normal weight 18.5 24.9
• Overweight 25.0 29.9
• Obese gt 30.0
• A woman who is 5 5 would need to weigh 180
  pounds to have a BMI of 30.
• Source Centers for Disease Control and
  Prevention

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Study Question

• Are obese women in Utah at increased risk for
  adverse pregnancy outcomes?

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Methodology

• Utah PRAMS data from 2000 2002 were evaluated.
  
• Excluded teen mothers due to different
  classification system.
• 4,577 completed surveys represented 127,055
  births.
• Chi-squared and regression analysis were
  performed.
• SAS 9.1 and SUDAAN.

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Obesity Demographics

• When compared to women with a normal BMI,
  significantly higher rates of obesity were noted
  among women who were
• older
• less educated
• of non-White race
• of higher parity
• of lower poverty status
• enrolled in WIC during pregnancy

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Prevalence of Maternal Diabetes by Prepregnancy
Body Mass Index,Utah PRAMS Data, 2000 - 2002
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Maternal Diabetes
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Prevalence of Maternal Hypertension by
Prepregnancy Body Mass Index,Utah PRAMS Data,
2000 - 2002
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Maternal Hypertension
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Prevalence of Fetal Macrosomia by Prepregnancy
Body Mass Index,Utah PRAMS Data, 2000 - 2002
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Macrosomia
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Labor Induction by Maternal Prepregnancy Body
Mass Index, Utah PRAMS Data, 2000-2002
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Labor Induction
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Admission of Infant to ICU by Maternal
Prepregnancy Body Mass Index,Utah PRAMS Data,
2000 - 2002
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Infant NICU Admission
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Postpartum Depression by Prepregnancy Body Mass
Index,Utah PRAMS Data, 2000 - 2002
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Postpartum Depression
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Labor Abnormality and Primary Cesarean Section
Rates,Utah Vital Records Data, 2000 -2002
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What Wasnt Significant?

• BMI was not significant when we examined
• All Cesarean Sections
• Preterm Birth
• Premature Rupture of Membranes
• Maternal hospital stay of 5 days

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Study Conclusions

• Obese women in Utah had significantly higher odds
  of developing adverse pregnancy outcomes.
• This is concerning as prepregnancy obesity rates
  continue to rise in Utah.

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Study Limitations

• Small numbers
• Reporting on birth certificate
• Self reported data
• BMI not definitive risk factor
• Cannot attribute poor outcome to body mass

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What Can We Take Home?

• BMI should be a part of vital sign recording and
  discussion.
• Interventions to improve preconceptional health
  in women must be emphasized.
• All women of reproductive age should be counseled
  about being at a healthy weight before becoming
  pregnant.
• Women who are not at an optimal weight should be
  informed of their increased risks.
• Practitioners should consider differences in
  labor progression by BMI before labor
  interventions or cesarean sections are undertaken.