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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2015

Open Access 01-12-2015 | Research article

Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study

Authors: Elizabeth A. Sullivan, Jan E. Dickinson, Geraldine A Vaughan, Michael J. Peek, David Ellwood, Caroline SE Homer, Marian Knight, Claire McLintock, Alex Wang, Wendy Pollock, Lisa Jackson Pulver, Zhuoyang Li, Nasrin Javid, Elizabeth Denney-Wilson, Leonie Callaway, on behalf of the Australasian Maternity Outcomes Surveillance System (AMOSS)

Published in: BMC Pregnancy and Childbirth | Issue 1/2015

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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/m2 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/m2 (range 40.9–79.9 kg/m2) 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.
Literature
1.
OECD. Health at a Glance 2013: OECD Indicators. Edited by EOECD. Paris, France: OECD Publishing; 2013.
2.
Hilder L, Zhichao Z, Parker M, Jahan S, Chambers G. Australia’s mothers and babies 2012. AIHW, editor. Perinatal statistics series no 30. Canberra: AIHW; 2014.
3.
Mason EE, Doherty C, Maher JW, Scott DH, Rodriguez EM, Blommers TJ. Super obesity and gastric reduction procedures. Gastroenterol Clin N Am. 1987;16(3):495–502.
4.
Marshall NE, Guild C, Cheng YW, Caughey AB, Halloran DR. Maternal superobesity and perinatal outcomes. Am J Obstet Gynecol. 2012;206(5):417. e411–416.CrossRefPubMedPubMedCentral
5.
Alanis MC, Goodnight WH, Hill EG, Robinson CJ, Villers MS, Johnson DD. Maternal super-obesity (body mass index > or = 50) and adverse pregnancy outcomes. Acta Obstet Gynecol Scand. 2010;89(7):924–30.CrossRefPubMed
6.
Mbah A, Kornosky J, Kristensen S, August E, Alio A, Marty P, et al. Super-obesity and risk for early and late pre-eclampsia. Br J Obstet Gynaecol. 2010;117(8):997–1004.CrossRef
7.
Knight M, Kurinczuk J, Spark P, Brocklehurst P, on behalf of the UK Obstetric Surveillance System (UKOSS). Extreme Obesity in Pregnancy in the United Kingdom. Am Coll Obstet Gynecol. 2010;115(5):9.CrossRef
8.
McIntyre HD, Gibbons KS, Flenady VJ, Callaway LK. Overweight and obesity in Australian mothers: epidemic or endemic? Med J Aust. 2012;196(3):184–8.CrossRefPubMed
9.
Halliday LE, Peek MJ, Ellwood DA, Homer C, Knight M, McLintock C, et al. The Australasian Maternity Outcomes Surveillance System: An evaluation of stakeholder engagement, usefulness, simplicity, acceptability, data quality and stability. Aust N Z J Obstet Gynaecol. 2012;53(2):152–7.CrossRefPubMed
10.
Lindquist A, Noor N, Sullivan E, Knight M. The impact of socioeconomic position on severe maternal morbidity outcomes among women in Australia: a national case–control study. BJOG. 2014. doi:10.​1111/​1471-0528.​13058.
11.
ABS. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011,. In. Edited by ABS. Canberra ACT; 2013.
12.
Vaughan G, Pollock W, Peek MJ, Knight M, Ellwood D, Homer CS, et al. Ethical issues: The multi-centre low-risk ethics/governance review process and AMOSS. Aust N Z J Obstet Gynaecol. 2012;52(2):195–203.CrossRefPubMed
13.
Verdiales M, Pacheco C, Cohen WR. The effect of maternal obesity on the course of labor. J Perinat Med. 2009;37(6):651–5.CrossRefPubMed
14.
Chu S, Kim S, Schmid C, Dietz P, Callaghan W, Lau J, et al. Maternal obesity and risk of cesarean delivery: a meta-analysis. Obesity Reviews. 2007;8(5):385–94.CrossRefPubMed
15.
Poobalan A, Aucott L, Gurung T, Smith W, Bhattacharya S. Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women--systematic review and meta-analysis of cohort studies. Obesity Reviews. 2009;10(1):28–35.CrossRefPubMed
16.
Martin A, Krishna I, Ellis J, Paccione R, Badell M. Super obesity in pregnancy: difficulties in clinical management. J Perinatol. 2014;34(7):495–502.CrossRefPubMed
17.
Schmied VA, Duff M, Dahlen HG, Mills AE, Kolt GS. ‘Not waving but drowning’: a study of the experiences and concerns of midwives and other health professionals caring for obese childbearing women. Midwifery. 2011;27(4):424–30.CrossRefPubMed
18.
Homer CSE, Kurinczuk JJ, Spark P, Brocklehurst P, Knight M. Planned vaginal delivery or planned caesarean delivery in women with extreme obesity. BJOG. 2011;118(4):480–6.CrossRefPubMed
19.
McLintock C, Brighton T, Chunilal S, Dekker G, McDonnell N, McRae S, et al. Recommendations for the prevention of pregnancy-associated venous thromboembolism. ANZJOG. 2012;52:3–13.PubMed
20.
National Health and Medical Research Council: Clinical practice guideline for the prevention of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to Australian hospitals. Melbourne: NHMRC; 2009.
21.
The Women’s Hospital: Thromboprophylaxis. Caesarean Section. In: Policy, Guideline and Procedure Manual. Melbourne: The Women’s Hospital; 2013. p. 4.
22.
Catalano PM, Ehrenberg HM. The short- and long-term implications of maternal obesity on the mother and her offspring. BJOG. 2006;113(10):1126–33.CrossRefPubMed
23.
Li Z, Zeki R, Hilder L, Sullivan EA. Australia’s mothers and babies 2010. In: Perinatal statistics series no 27 Cat no PER 57. Canberra: AIHW National Perinatal Epidemiology and Statistics Unit; 2012.
24.
RANZCOG: Management of Obesity in Pregnancy. College statement., vol. C-Obs 49. Melbourne: RANZCOG; 2013: 9.
25.
National Institute for Health and Clinical Excellence: Obesity: Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. Edited by National Institute for Health and Clinical Excellence (NIHCE); 2006.
26.
Dalfra MG, Busetto L, Chilelli NC, Lapolla A. Pregnancy and foetal outcome after bariatric surgery: a review of recent studies. J Matern Fetal Neonatal Med. 2012;25(9):1537–43.CrossRefPubMed
27.
Lapolla A, Marangon M, Dalfra MG, Segato G, De Luca M, Fedele D, et al. Pregnancy outcome in morbidly obese women before and after laparoscopic gastric banding. Obes Surg. 2010;20(9):1251–7.CrossRefPubMed
28.
Weintraub AY, Levy A, Levi I, Mazor M, Wiznitzer A, Sheiner E. Effect of bariatric surgery on pregnancy outcome. Int J Gynaecol Obstet. 2008;103(3):246–51.CrossRefPubMed
29.
Eerdekens A, Debeer A, Van Hoey G, De Borger C, Sachar V, Guelinckx I, et al. Maternal bariatric surgery: adverse outcomes in neonates. Eur J Pediatr. 2010;169(2):191–6.CrossRefPubMed
30.
Dodd J, Grivell R, Crowther C, Robinson J. Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials. BJOG. 2010;117:1316–26.CrossRefPubMed
31.
van der Pligt P, Willcox J, Hesketh KD, Ball K, Wilkinson S, Crawford D, et al. Systematic review of lifestyle interventions to limit postpartum weight retention: implications for future opportunities to prevent maternal overweight and obesity following childbirth. Obes Rev. 2013;14(10):792–805.CrossRefPubMed
32.
Vrebosch L, Bel S, Vansant G, Guelinckx I, Devlieger R. Maternal and neonatal outcome after laparoscopic adjustable gastric banding: a systematic review. Obes Surg. 2012;22(10):1568–79.CrossRefPubMed
33.
Callaway LK, Prins JB, Chang AM, McIntyre HD. The prevalence and impact of overweight and obesity in an Australian obstetric population. Med J Aust. 2006;184(2):56–9.
34.
NSW Department of Health. ObstetriX Perinatal data collection. Edited by NSW Department of Health. Sydney: NSW Department of Health; 2010.
35.
Queensland Health. Perinatal data collection. Edited by Queensland Health. Brisbane: Queensland Health; 2010.
36.
Western Australia Department of Health. Perinatal data collection. Edited by WA Department of Health. Perth: Western Australia Department of Health; 2010.
37.
Homer CSE, Biggs J, Vaughan G, Sullivan EA. Mapping maternity services in Australia: location, classification and services. Aust. Health Rev. 2011;35(2):222-9
38.
Heslehurst N, Ells LJ, Simpson H, Batterham A, Wilkinson J, Summerbell CD. Trends in maternal obesity incidence rates, demographic predictors, and health inequalities in 36 821 women over a 15-year period. BJOG: An International Journal of Obstetrics & Gynaecology. 2007;114(2):187–94.
39.
Kim SY, Dietz P, England L, Morrow B, Callaghan WM. Trends in pre-pregnancy obesity in nine states, 1993-2003. Obesity. 2007;15(4):986–93.
40.
Nagahawatte NT, Goldenberg RL. Poverty, Maternal Health, and Adverse Pregnancy Outcomes. Annals of the New York Academy of Sciences. 2008;1136(1):80–5.
41.
Australian Institute of Health and Welfare. Australia’s health 2014. Canberra: AIHW, 2014
Metadata
Title
Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study
Authors
Elizabeth A. Sullivan
Jan E. Dickinson
Geraldine A Vaughan
Michael J. Peek
David Ellwood
Caroline SE Homer
Marian Knight
Claire McLintock
Alex Wang
Wendy Pollock
Lisa Jackson Pulver
Zhuoyang Li
Nasrin Javid
Elizabeth Denney-Wilson
Leonie Callaway
on behalf of the Australasian Maternity Outcomes Surveillance System (AMOSS)
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2015
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-015-0693-y

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