ORIGINAL ARTICLE Year : 2022  |  Volume : 66  |  Issue : 4  |  Page : 448-450  

Study of maternal and fetal outcomes in obese women

Mansi Kumar, Kimaya A Mali
Assistant Professor, Department of Obstetrics and Gynecology, Seth GSMC and Kem Hospital, Mumbai, Maharashtra, India

Date of Submission29-Sep-2021Date of Decision14-Oct-2022Date of Acceptance15-Oct-2022Date of Web Publication31-Dec-2022

Correspondence Address:
Mansi Kumar
272 Seemant Vihar Sector 14, Kaushambi, Ghaziabad - 201 010, Uttar Pradesh
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/ijph.ijph_1862_21

   Abstract 

Background: Obesity in Indian women had increased from 10.6% to 14.8% in India. Mothers who are overweight or obese during pregnancy and childbirth cause significant antenatal, intrapartum, postpartum and also neonatal complications. Aim and Objective: The present study aimed to explore various maternal and fetal outcomes influenced by maternal obesity. The objective was to find the effect of obesity on maternal and perinatal outcome among obese pregnant women compared to those of normal weight. Methods: The study was conducted in antenatal women attending antenatal outpatient department of of Obstetrics and Gynecology in a teriary care referral hospital in Mumbai. Results recorded in simple percentages. Results: Eighteen percent cases developed gestational diabetes mellitus during their antenatal period and 15% developed gestational hypertension. 44% patients underwent lower segment caesarean section. The need for induction of labour and caesarean section was found to be 37% which is significantly higher. Increased NICU admissions due to hypoglycemia or congenital malformations,prematurity was found to be on a higher side. Conclusions: It was clearly evident from the present study that maternal obesity had adverse maternal and fetal outcomes. Maternal obesity was strongly associated with antenatal complications like gestational diabetes mellitus, gestational hypertension, preeclampsia and increase in need for induction of labour and operative interference.

Keywords: Fetal outcome, maternal outcome, obese women

How to cite this article:
Kumar M, Mali KA. Study of maternal and fetal outcomes in obese women. Indian J Public Health 2022;66:448-50

The worldwide prevalence of obesity has increased markedly over the past few decades and the World Health Organization (WHO) has described this trend as a “global epidemic” posing a serious threat to public health.[1] The increasing prevalence of obesity in women of childbearing age is of particular concern as obesity in pregnancy carries additional risks for the mother and baby.[2] Prematernal obesity is an important risk factor for antepartum, intrapartum, and postpartum complications. Obesity increases morbidity for both mother and fetus and is associated with a variety of adverse reproductive outcomes. Understanding of obesity as an obstetric risk factor is important and management should start before pregnancy and continue throughout the postpartum period. There appears to be a dose-dependent relationship between maternal obesity and macrosomia.[3] In addition, stillbirths and increased mortality of babies in postnatal women are found in babies of obese women.[4] The objective of this study was to see the effect of obesity on maternal and fetal outcomes in obese women.

The WHO categorizes body mass index (BMI) (kg/m2) into six classes as follows: [5]

Underweight 18.5Normal 18.5–24.99Overweight 25–29.9Class I 30–34.99Class II 35–39.99Class III 40.

A prospective observational study was conducted in a tertiary care hospital for 6 months. A standardized questionnaire was used and details of medical history, clinical examination, and maternal history during antenatal, natal, and postpartum periods were collected. For measuring height, a stadiometer was used. For measuring weight, a standardized scale was used. BMI was assessed before 20 weeks of gestation and patients with a BMI of more than 30 kg/m2 were included in the study. Antenatal registrations after 20 weeks of pregnancy and multifetal gestation were excluded from the study.

The study protocol was approved by the institutional ethics committee of the study institute and written informed consent was taken from the subjects. Relevant hematological and biochemical investigations and Ultrasonography (USG) were done. Patients were followed up to delivery and postpartum until discharge and outcome studied.

The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Helsinki Declaration of 1975, as revised in 2000.

Pregnancy complications associated with maternal BMI are a growing problem as shown in [Table 1] and [Table 2]. In the present study, gestational hypertension was seen in 27% and preeclampsia in 15% (P = 0.001). In the study conducted by Dasgupta et al., 55.5% of cases of preeclampsia were in the morbidly obese category and 71.4% of obese patients had preeclampsia.[6] Bhattacharya et al. found that 28.2% of obese women had gestational hypertension with a P = 0.05.[7]

Gestational diabetes was seen in 18% of obese women, whereas similar studies conducted by Verma et al. and Demont-Heinrich et al. showed 23% and 7.5% risk of gestational diabetes, respectively.[8],[9] There is an increased risk of spontaneous abortions and recurrent abortions in obese women as compared with the controls. Furthermore, pregnant women are at increased risk of neural tube defects and cardiovascular and limb reduction defects. Four babies had congenital malformations in the form of tracheoesophageal fistula, tetralogy of Fallot, hydrocephalus with corpus callosum agenesis, and spina bifida.

The present study shows the rate of cesarean section and instrumental deliveries increased significantly with BMI, being 42% and 12%, respectively. In a similar study conducted by Bhattacharya et al., lower-segment cesarean section was seen in 42.7% and 30.8% of the morbidly obese and obese groups, respectively.[7] The same study by Bhattacharya et al. showed 24.2% instrumental/assisted vaginal delivery.[7]

Induction of labor was done in 37.2% of cases, whereas Dasgupta et al. found 64.2% induced labor in morbidly obese; Yazdani et al., Bhattacharya et al., Demont-Heinrich et al. showed 50%, 49%, 41.4%, respectively.[6],[7],[9],[10]

When considering the intrapartum complications, the study of Bianco et al. reported abruption placenta (0.5%), and shoulder dystocia (1.6%). An inverse relationship exists between increasing BMI and the trial of labor after cesarean section. Furthermore, pregnant women with class III obesity had prolonged hospital stay, endometritis, and wound disruption. In the postpartum period, 19% of patients had a postpartum hemorrhage (PPH).

Pregnant women with class II or class III obesity have been shown to have a high chance of atonic PPH in vaginal delivery as compared to cesarean delivery. A similar study by Dasgupta et al. showed 31.6% PPH in the morbidly obese group.[6] This study shows the risk of wound infection of around 8.5% compared to 4% in the study of Yazdani et al.[10] Furthermore, the study of Varma et al. shows a risk of 22.2%.[8]

The present study had 37.2% of patients with preterm births similar to studies of Demont-Heinrich et al. which showed statistical significance.[9] The incidence of stillbirths in the current study was 6.3%. The rate of stillbirth was higher among macrosomic infants born to mothers with obesity compared to those without obesity. In the study of Dasgupta et al., the prevalence of infection in morbidly obese was seen in 15.8%.[6]

Large for gestational age babies were seen in 6.3% of the babies comparable to studies carried out by Verma et al. and Demont-Heinrich et al. showed that large for gestational age in morbidly obese BMI was seen in 23% and 14%, respectively, with statistical significance.[8],[9]

Optimal control of obesity should begin in the preconceptional period. Even small reductions in weight gain lead to improved pregnancy outcomes. Primary weight management strategies include dietary modifications and exercise. Anorectic drugs for weight management are not recommended in pregnancy. For better outcomes in these women, periconceptional counseling before pregnancy is to be undertaken.

Acknowledgment

We would like to thank all the study participants who gave consent for the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

   References 
1.World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Geneva: World Health Organization; 2000.  
    2.Heslehurst N, Simpson H, Ells LJ, Rankin J, Wilkinson J, Lang R, et al. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: A meta-analysis. Obes Rev 2008;9:635-83.  
    3.Ehrenberg HM, Mercer BM, Catalano PM. The influence of obesity and diabetes on the prevalence of macrosomia. Am J Obstet Gynecol 2004;191:964-8.  
    4.Papachatzi E, Papadopoulos V, Dimitriou G, Paparrodopoulos S, Papadimitriou-Olivgeris M, Vantarakis A. Prepregnancy maternal obesity and fetal-perinatal death in a mediterranean country. J Perinat Med 2015;43:291-8.  
    5.National Institute for Health and Clinical Excellence. Obesity. Guidance on the Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children. London: National Institute for Health and Clinical Excellence (NICE); 2006.  
    6.Dasgupta A, Harichandrakumar KT, Habeebullah S. Pregnancy outcome among obese Indians – A prospective cohort study in a tertiary care centre in South India. Int J Sci Stud 2014;2:13-8.  
    7.Bhattacharya S, Campbell DM, Liston WA, Bhattacharya S. Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies. BMC Public Health 2007;7:168.  
    8.Verma M, Rajput M, Sahoo SS, Kaur N, Rohilla R. Correlation between the percentage of body fat and surrogate indices of obesity among adult population in rural block of Haryana. J Family Med Prim Care 2016;5:154-9.  
[PUBMED]  [Full text]  9.Demont-Heinrich C. The association of prepregnancy body mass index and adverse maternal and perinatal outcomes; Colorado department of public health and environment. In: Health Statistics Section. Colorado Department of Public Health and Environment; 2009.  
    10.Yazdani S, Yosofniyapasha Y, Nasab BH, Mojaveri MH, Bouzari Z. Effect of maternal body mass index on pregnancy outcome and newborn weight. BMC Res Notes 2012;5:34.  
    

 
 

  [Table 1], [Table 2]