Maternal and fetal outcome in obesity complicating pregnancies

Shanthi, E (2007) Maternal and fetal outcome in obesity complicating pregnancies. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: In general, pregnancy in women is considered unique, physiologically normal episode in women’s life. However preexisting morbidity of the mother or fetus can complicate pregnancy and as well as those arising during pregnancy and intrapartum make it a high risk one. “A pregnancy is defined as high risk, when the probability of an adverse outcome for the mother or child is increased over the base line risk of that outcome among the general population by the presence of one or more ascertainable risk factors”. “One such pre-existing maternal morbidity that makes a pregnancy high risk is obesity”.The magnitude of the obesity prevalence has been increasing in developed and developing nations, though in varying degrees. Also coming with the increase in obesity prevalence, inevitably, are the morbidities obesity promotes, including cardiovascular disease, diabetes, hypertension, stroke etc. It becomes a major issue when it affects the women of reproductive age group, as obesity makes a pregnancy high risk, by the increased incidence of gestational diabetes, preeclampsia, gestational hypertension, labour induction, increased cesarean rates, anesthetic complications, postoperative morbidity, prolonged hospital stay etc. They are at increased risk of delivering large babies and NICU admission. Although routine weighing of pregnant women is being carried out in most of the antenatal clinics, not much of importance is given to the weight of the women as such. In fact prenatal counseling plays a vital role in identifying women who are obese. Advice on weight reduction before embarking on pregnancy will go a long way in reducing the morbidity due to obesity in pregnancy. AIM OF THE STUDY: The aim of this study is to evaluate the effect of obesity on the maternal and perinatal outcome in pregnancies complicated by obesity. MATERIALS AND METHODS: Study Design: Prospective Cohort Study. Period of Study: July 2005 – June 2006. Place of Study: Institute of Obstetrics and Gynecology, Egmore, Chennai. Case Selection - Among antenatal mothers attending antenatal outpatient department, mothers were chosen in their first trimester who had Body Mass Index > 30kg /m2 as study group and mothers with a Body Mass Index between 18.5 kg/m2 and 25kg/m2 as control group. Inclusion Criteria - 1. Pregnant women with first trimester BMI >30kg/m2. 2. Pregnant women with first trimester BMI between 18.5kg/m2 and 25kg/m2. 3. Irrespective of age, parity, socio-economic status. Exclusion Criteria - 1. Mothers not booked at First Trimester 2. Miscarriage 3. Anomalous baby 4. Women with BMI between 25.1kg/m2 and 29.9kg/m2. 5. Women with BMI <18.5kg/m2. 6. Women who could not be followed until delivery Method of Study: Pregnant mothers were selected according to the criteria and in all women detailed history followed by complete general and physical examination was done. Relevant hematological, biochemical investigations, USG were done. They were followed up to delivery and postpartum until discharge and outcome studied. SUMMARY: In our study, 99 obese women (BMI>30kg/m2 ) and 201 women with normal BMI (18.5kg/m2 _ 24.99kg/m2) were studied. It was observed that: 1. Obese women were slightly older than control group. Majority of obese women belonged to age group 25-29yrs when compared to control group ,who belonged to 20-24years age group. 2. The mean age of obese women was 27.01yrs and that of control women was 24.14yrs. 3. The proportion of nulliparous women was less in obese group (36.36%) when compared to control group (45.77). 4. In obese group, the mean BMI increased with increase in parity. 5. Among obese group, majority (82.82%) was moderately obese, 12.12% were severely obese and 5.56% were very severely obese. 6. 18.18% of obese women had menstrual abnormalities when compared to 2.49% of control women. 7. Infertility was seen in 20.2% of obese group and 2.49% in control group 8. Obese women had increased incidence of pre-existing medical disorders like hypothyroidism, when compared to control group. But no difference was seen with respect to diabetes, hypertension and other morbidities between the two groups. 9. Obese women had increased incidence of gestational diabetes when compared to control group (10.10% Vs 1.99%) . Obese group had 5.53 fold increased risk of gestational diabetes. 10. The incidence of pre -eclampsia was higher in obese group when compared to control group (13.13% Vs 5.97%). Obese women had 2.3 fold increased risk of developing pre-eclampsia. 11. Gestational hypertension was found to be higher in obese group when compared to control group (10.10% Vs 2.99%). The risk of gestational hypertension among obese group was increased almost 3.6 fold. 12. Obese women were more likely to be induced (12.1%, Odd’s Ratio: 2.55) when compared to control group (4.9%). 13. Increased cesarean delivery rates was found among obese women (56.57%, Odd’s Ratio 2.8) when compared to control group (30.35%). The risk increased with increase in severity of obesity. 14. Nulliparous women had 2.5 fold increased risk of cesarean delivery when compared to women with normal BMI. 15. Emergency primary cesarean deliveries were higher among obese group (31.34%, Odd’s Ratio: 2.13,) when compared to control group (17.64%). Similarly elective primary cesarean delivery was also fond to be higher in obese group (5.97%, Odd’s Ratio: 2.09) when compared to control group(2,94%) 16. No difference was seen among obese and control group with respect to placenta previa, abruptio placenta, malpresentation, multiple pregnancy, instrumental deliveries, shoulder dystocia, complete perineal tears and hemorrhage. 17. Post operative wound infections and wound dehiscence were found to be increased in obese group (23.2%, 8.93%) when compared to control group (9.84%, 1.67%) respectively(Odd’s Ratio: 2.47 and 3.12 respectively). 18. No difference was found in preterm births (<37 weeks) between two groups 19. The majority of the neonates of obese women (44%) were between 3kg-3.49kg where as majority of neonates in control group (48.28%) were between 2.5kg – 2.99kg. 20. Three babies of obese women were >4kg but none were in control group. 21. No difference was seen among obese and control group with respect to Apgar score at 5 Minutes. (3% Vs 0.49%) respectively. 22. There were increased admissions to NICU among neonates of obese women (21%) when compared to control group (8.37%). The major reasons for admissions were for the care of infant of diabetic mother and macrosomia. 23. There was one still birth and one early neonatal death in obese group due to prematurity. None were there in control group Prolonged hospital stay was required in obese group (26.26%) when compared to control group (10.95%). The major reasons for the prolonged stay were due to wound infections, medical disorders and NICU admissions. CONCLUSION: Our study points out the numerous maternal and perinatal risks in obese pregnant women which pose a considerable challenge to the obstetrical practitioner. In addition, massive obesity among women of child bearing age is associated with a number of health risks later in life. This stresses the importance of concentrating on trying to reduce the increasing incidence of obesity in fertile women. The best time of intervention may be before a women considers a pregnancy, because it is not recommended that obese women lose weight during pregnancy. This implicates the need of pre-pregnancy advice and counseling to young women. Obese women considering pregnancy should be informed of the risk that maternal obesity confers on a pregnancy. Health care professionals need to encourage and assist obese women to make life style changes, to lose weight pre-conceptually in an attempt to optimize and potentially decrease the risk of complication in pregnancy. Pregnancies among obese women must be classified as high risk pregnancies and appropriate antenatal care should be provided with heightened surveillance, anticipation and diagnosis of the complications and intervene earlier if complications arise.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Maternal and fetal outcome ; obesity ; complicating pregnancies.
Subjects: MEDICAL > Obstetrics and Gynaecology
Depositing User: Subramani R
Date Deposited: 03 Dec 2017 11:07
Last Modified: 09 Dec 2017 01:58
URI: http://repository-tnmgrmu.ac.in/id/eprint/4168

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