PROSPECTIVE STUDY ON EFFECT OF

OBESITY ON MATERNAL AND FETAL

OUTCOMES IN OBESE PREGNANT
WOMEN
P PAVANI,
2nd year PG(OBG),
Government Medical College,
Anantaapur.
Introduction
• Obesity is a major public health problem across the world.
• The proportion of children and adult who are obese or overweight has
increased rapidly in last three decades.
• The WHO recognizes obesity as a pandemic issue, with prevalence
more in females than in males.
• Pregnancy with obesity is a high risk pregnancy. It causes adverse
maternal and fetal outcomes.
Objectives
• To study adverse maternal and fetal outcomes in pregnant women with
obesity.
Materials and methods
• This study was conducted for a period of 1 year from november 1,
2020 to october 31, 2021 in Department of Obstetrics and
Gynaecology, Government medical college, Anantapur.
• 422 pre-pregnant obese women and 422 non obese pregnant were
enrolled in the study group and in the control group respectively.
• Inclusion criteria into the study group was pregnant mothers with BMI
of 32±2.2kg/m2 and singleton pregnancies.
• Obese pregnant women presenting with medical disorders and
multiple pregnancies were excluded from the study.
• Controls were selected with BMI of 20.9±2.4 kg/m2.
• All women were enrolled in to study groups and controls based on their
BMI in pre-pregnant state and at the first antenatal check up.
• All pregnant women were followed up with regular antenatal checkups,
USG and other special investigations to detect adverse maternal and
fetal outcomes.
• They were admitted in our antenatal ward in due time for timely
management and intervention.
• High risk pregnant mothers were monitored with biweekly
cardiotochography, DFMC and daily fetal heart rate monitoring.
• Complications if any, were treated as per protocol.
• Mode of delivery was decided based on obstetric indication.
• On sixth week follow-up all patients were again scrutinized for the
outcomes and complications.
• Fisher's exact test was employed to compare categorical variables
between obese and control subjects.
• The strength of association had been expressed as the odd ratio of obese
versus control along with 95% confidential interval values.
• A p value < 0.05 was considered statistically significant.
RESULTS
Patients distribution and previous obstetric data of obese pregnant
women
age in years number of cases parity number of cases route of number of cases
N=422 N=422 delivery N=96
18-24 82 primigravidae 326 LSCS 36
24-32 300 multigravidae 96 Vaginal delivery 50
33-38 40 instrumental 10

Routes of deliveries in obese and controls

route of delivery obese controls OR(CI-95%) p value
Emergency LSCS 155(36.2%) 74(17.53%) 2.65(1.922-3.647) <0.001
Elective LSCS 93(22.03%) 66(15.63%) 1.59(1.122-2.49) 0.011
Spontaneous VD 116(27.48%) 259(61.37%) 0.24(0.179-0.319) <0.001
Instrumental 52(12.32%) 22(5.21%) 2.56(1.522-4.241) <0.001
delivery
 Indications for cesarean section and labor induction
cesarean section obese women (n=248) control (n=140)
previous uterine scar 30(12.09%) 23(16.42%)
fetal distress 64(25.8%) 52(37.14%)
breech 9(3.62%) 6(4.28%)
labor induction failure 60(24.19%) 30(21.42%)
PIH 7(2.82%) 2(1.42%)
pre eclampsia 37(14.91%) 14(10.0%)
arrest of cervical dilation 22(8.87%) 11(7.85%)

macrosomia 19(7.6%) 02(1.4%)

labor induction obese women control
rupture of membranes 43(16.16%) 32(21.33%)

diabetes mellitus 79(26.69%) 10(6.66%)

hypertension 42(15.78%) 8(5.33%)
postdated pregnancy 34(12.78%) 20(13.33%)
programmed delivery 68(25.56%) 80(32.0%)
Intrapartum and postpartum complications in
obese and control groups
Intrapartum complications obese(n=422) controls(n=422 OR (CI - 95%) p value
)
Meconium stained liquor 86(20.37%) 52(12.32%) 1.82(1.252-2.649) 0.002
Non progress of labor 62(14.69%) 23(5.43%) 3.13(1.886-5.199) <0.001
Shoulder dystocia 11(2.6%) 2(0.47%) 5.62(1.237-25.52) 0.022
Perianal and cervical tear 40(9.47%) 10(2.36%) 4.31(2.128-8.748) <0.001
Post partum complications
Endometritis and wound 42(9.95%) 16(3.79%) 2.8(1.551-5.073) <0.001
infection
PPH 23(5.45%) 17(4.02%) 1.39(0.722-2.697) 0.407
peurperial pyrexia 32(7.58%) 10(2.36%) 3.38(1.64-6.97) <0.001
Total hospital stay > 7days 53(12.55%) 24(5.68%) 2.56(1.521-4.291) <0.001
Maternal outcomes in obese and controls
maternal outcome obese control OR(CI95%) p value
gestational diabetes mellitus 82(19.43%) 16(3.79%) 6.12(3.51-10.65) <0.001
PIH 52(12.32%) 10(2.36%) 5.76(2.90-11.56) <0.001
Preeclampsia 37(8.76%) 14(3.31%) 2.80(1.491-5.263) 0.001
Preterm labor <37weeks 22(5.21%) 24(5.68%) 0.91(0.503-1.654) 0.880
Preterm labor <34 weeks 32(7.58%) 15(3.55%) 2.23(1.187-4.176) 0.016
UTI 62(14.69%) 21(4.97%) 3.29(1.965-5.504) <0.001
Thromboembolic phenomenon 5(1.18%) 0 11.13(0.613-202.9) 0.062
Chronic hypertension 22(5.21%) 2(0.47%) 11.55(2.698-49.454) <0.001
overt diabetes mellitus 10(2.36%) 0 21.51(1.256-368.51) 0.002
IUFD 6(1.42%) 1(0.23%) 6.22(0.746-51.993) 0.066
Maternal mortality 0 0 0 0
Fetal outcomes in obese and controls
fetal outcome Obese (n=414) Control OR(CI-95%) p value
(n=421)
birth weight <2.5kg 32(7.72%) 42(9.97%) 0.76(0.467-1.223) 0.0274
birth weight >3.5kg 92(22.28%) 12(2.85%) 9.74(5.24-18.08) <0.001
preterm babies <34weeks 32(7.72%) 15(3.56% 2.23(1.187-4.176) 0.016
preterm <37weeks 22(5.31%) 24(5.7%) .91(.503-1.654) 0.880
samll for gestational age 36(8.69%) 64(15.2%) .53(.334-.819) 0.004
large for gestational age 192(46.37%) 82(19.47%) 3.58(2.625-4.871) <0.001
Infant birth trauma 10(2.41%) 0 21.8(1.27-344.97) <0.001
Recoveries in NICU 86(20.77%) 82(19.47%) 1.084(.773-1.52) 0.667
Congenital anomaly 5(1.2%) 1(0.23%) 5.13(.597-44.162) 0.012
Neonatal motality 2(0.48%) 0 5.11(.244-106.82) O.246
Discussion
• Majority of the obese pregnant women in our study were aged
between 25 and 32 years and among them 326 (77.25%) were
primigravida.
• Obese pregnant women required more often cesarean sections and
instrumental deliveries as mode of termination. Rate of labor induction
was also higher in obese pregnant women.
• Increased incidences of morbidities like; GDM,PIH, pre
eclampsia,urinary tract infection and thromboembolism.
• They were also prone to develop overt diabetes and chronic
hypertension in future.
• Most of the newborns born to obese pregnant women were large for
gestational age and had birth weight more than 3.5 kg.
• As a result obese group had high incidence of shoulder dystocia, birth
canal trauma and infant birth trauma at the time of delivery than
average weight women.
Conclusion
• Obesity became an independent risk factor for adverse maternal and
fetal outcomes.
• As it is modifiable and preventable risk factor, preconception
counseling, treatment of obesity before conception and creating
awareness regarding risks associated with it are highly desirable.