Influence of Maternal Obesity on Labor Induction: A Systematic Review and Meta-Analysis

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Abstract

Studies have shown that women with obesity have longer labors. The purpose of this systematic review and meta-analysis is to examine existing evidence regarding labor induction in women with obesity, including processes and outcomes. The primary outcome was cesarean birth following labor induction. Secondary outcomes were the timing and dosage of prostaglandins, the success of mechanical cervical ripening methods, and synthetic oxytocin dose and timing.

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Is obesity still increasing among pregnant women? Prepregnancy obesity trends in 20 states, 2003-2009.

Heidi Fisher, R Rochat, Jayne Morrow … (2013)

To estimate trends in prepregnancy obesity prevalence among women who delivered live births in the US during 2003-2009, by state, age, and race-ethnicity. We used Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2003, 2006, and 2009 to measure prepregnancy obesity (body mass index [BMI]≥30kg/m(2)) trends in 20 states. Trend analysis included 90,774 records from 20 US states with data for all 3 study years. We used a chi-square test for trend to determine the significance of actual and standardized trends, standardized to the age and race-ethnicity distribution of the 2003 sample. Prepregnancy obesity prevalence increased by an average of 0.5 percentage points per year, from 17.6% in 2003 to 20.5% in 2009 (P<0.001). Obesity increased among women aged 20-24 (P<0.001), 30-34 (P=0.001) and 35 years or older (P=0.003), and among non-Hispanic white (P<.001), non-Hispanic black (P=0.02), Hispanic (P=0.01), and other women (P=0.03). Overall, prepregnancy obesity prevalence continues to increase and varies by race-ethnicity and maternal age. These findings highlight the need to address obesity as a key component of preconception care, particularly among high-risk groups. Published by Elsevier Inc.

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Reassessing the labor curve in nulliparous women.

Jun Zhang, James Troendle, Antronette Yancey (2002)

Our purpose was to examine the pattern of labor progression in nulliparous parturients in contemporary obstetric practice. We extracted detailed labor data from 1329 nulliparous parturients with a term, singleton, vertex fetus of normal birth weight after spontaneous onset of labor. Cesarean deliveries were excluded. We used a repeated-measures regression with a 10th-order polynomial function to discover the average labor curve under contemporary practice. With use of an interval-censored regression with a log normal distribution, we also computed the expected time interval of the cervix to reach the next centimeter, the expected rate of cervical dilation at each phase of labor, and the duration of labor for fetal descent at various stations. Our average labor curve differs markedly from the Friedman curve. The cervix dilated substantially slower in the active phase. It took approximately 5.5 hours from 4 cm to 10 cm, compared with 2.5 hours under the Friedman curve. We observed no deceleration phase. Before 7 cm, no perceivable change in cervical dilation for more than 2 hour was not uncommon. The 5th percentiles of rate of cervical dilation were all below 1 cm per hour. The 95th percentile of time interval for fetal descent from station +1/3 to +2/3 was 3 hours at the second stage. Our results suggest that the pattern of labor progression in contemporary practice differs significantly from the Friedman curve. The diagnostic criteria for protraction and arrest disorders of labor may be too stringent in nulliparous women.

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Maternal obesity and labour complications following induction of labour in prolonged pregnancy

S Arrowsmith, S. Wray, S. Quenby (2011)

Objective To investigate the effect of maternal obesity on mode of delivery following induction of labour (IOL) for prolonged pregnancy and subsequent intrapartum and neonatal complications. Design Retrospective (historical) cohort study. Setting Liverpool Women's Hospital NHS Foundation Trust, UK. Population A total of 29 224 women with singleton pregnancies between 2004 and 2008 of whom 3076 had a prolonged pregnancy (defined as ≥290 days or 41+3 weeks of gestation) and received IOL. Methods Kruskal–Wallis test, chi-square test and multivariable logistic regression. Main outcome measures Mode of delivery and risk of delivery and neonatal complications in obese verses non-obese women following IOL. Results Obese women had a significantly higher rate of IOL ending in caesarean section compared with women of normal weight following IOL (38.7% versus 23.8% primiparous; 9.9% versus 7.9% multiparous women, respectively); however, length of labour, incidence of postpartum haemorrhage and third-degree tear, rate of low cord blood pH, low Apgar scores and shoulder dystocia were similar in all body mass index categories. Complications included a higher incidence of fetal macrosomia and second-degree, but not third-degree, tear in primiparous women. Conclusions Higher maternal body mass index at booking is associated with an increased risk of prolonged pregnancy and increased rate of IOL. Despite this, more than 60% of obese primiparous and 90% of multiparous women with prolonged pregnancies who were induced achieved vaginal delivery and labour complications in the obese women with prolonged pregnancies were largely comparable to those of normal weight women with prolonged pregnancies. Our data suggest that IOL for prolonged pregnancy in obese women is a reasonable and safe management option.