Impact of body mass index and gestational weight gain on cesarean delivery rates: a comparative study of dinoprostone-induced vs spontaneous labor
Abstract
Objectives: This study investigates the relationship between pre-pregnancy body mass index (BMI), BMI before labor, and weight gain during pregnancy with the incidence of cesarean delivery (CD) in dinoprostone-induced labor versus spontaneous labor.
Material and methods: This retrospective analysis was carried out at the Jagiellonian University Hospital's Obstetrics and Perinatology Department, encompassing term singleton pregnancies from May 2019 to February 2021. BMI was categorized following WHO guidelines. Gestational weight gain was assessed against the Institute of Medicine's 2009 recommendations.
Results: Of the 366 cases reviewed, 183 were in the dinoprostone-induced labor group, and 183 were in the spontaneous labor group. The study identified a significant association between higher pre-pregnancy BMI and increased weight gain during pregnancy with elevated CD rates, especially in dinoprostone-induced labor compared to spontaneous labor. Specifically, the dinoprostone-induced labor group showed a 33.9% CD rate compared to 16.9% in the spontaneous labor group. Logistic regression analysis further established that for each 1 kg/m² increase in pre-pregnancy BMI, the odds of undergoing a CD increased by 10%.
Conclusions: Elevated pre-pregnancy BMI and excessive gestational weight gain significantly heighten the risk of cesarean delivery, particularly in induced labor. The findings underline the need for individualized labor management strategies for women with higher BMI to optimize maternal and neonatal outcomes.
Keywords: body mass indexpregnancy weight gaininduction of labordinoprostonecesarean section
References
- Bjorklund J, Wiberg-Itzel E, Wallstrom T. Is there an increased risk of cesarean section in obese women after induction of labor? A retrospective cohort study. PLoS One. 2022; 17(2): e0263685.
- Ellis JA, Brown CM, Barger B, et al. Influence of Maternal Obesity on Labor Induction: A Systematic Review and Meta-Analysis. J Midwifery Womens Health. 2019; 64(1): 55–67.
- Huras H, Fuchs T, Kwiatkowski S, et al. Opinia zespołu ekspertów Polskiego Towarzystwa Ginekologów i Położników dotycząca zastosowania produktu Cervidil w preindukcji/indukcji porodu. Ginekologia i Perinatologia Praktyczna. 2021;6(2):106-108. https://journals.viamedica.pl/ginekologia_perinatologia_prakt/article/view/84059 (29.08.2024).
- Shirley M. Dinoprostone Vaginal Insert: A Review in Cervical Ripening. Drugs. 2018; 78(15): 1615–1624.
- Gauthier T, Mazeau S, Dalmay F, et al. Obesity and cervical ripening failure risk. J Matern Fetal Neonatal Med. 2012; 25(3): 304–307.
- Bomba-Opoń D, Drews K, Huras H, et al. Polish Gynecological Society Recommendations for Labor Induction. Ginekol Pol. 2017; 88(4): 224–234.
- Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000; 894: i–xii, 1.
- Weight Gain During Pregnancy. 2009.
- Harrison W, Goodman D. Epidemiologic Trends in Neonatal Intensive Care, 2007-2012. JAMA Pediatr. 2015; 169(9): 855–862.
- Goldstein RF, Abell SK, Ranasinha S, et al. Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis. JAMA. 2017; 317(21): 2207–2225.
- Liu L, Ma Y, Wang N, et al. Maternal body mass index and risk of neonatal adverse outcomes in China: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2019; 19(1): 105.
- Poobalan AS, Aucott LS, Gurung T, et al. Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women--systematic review and meta-analysis of cohort studies. Obes Rev. 2009; 10(1): 28–35.
- Denison FC, Price J, Graham C, et al. Maternal obesity, length of gestation, risk of postdates pregnancy and spontaneous onset of labour at term. BJOG. 2008; 115(6): 720–725.
- Paidas Teefey C, Reforma L, Koelper NC, et al. Risk Factors Associated With Cesarean Delivery After Induction of Labor in Women With Class III Obesity. Obstet Gynecol. 2020; 135(3): 542–549.
- Wolfe KB, Rossi RA, Warshak CR. The effect of maternal obesity on the rate of failed induction of labor. Am J Obstet Gynecol. 2011; 205(2): 128.e1–128.e7.
- Voerman E, Santos S, Inskip H, et al. LifeCycle Project-Maternal Obesity and Childhood Outcomes Study Group. Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes. JAMA. 2019; 321(17): 1702–1715.
- Bahri Khomami M, Joham AE, Boyle JA, et al. The role of maternal obesity in infant outcomes in polycystic ovary syndrome-A systematic review, meta-analysis, and meta-regression. Obes Rev. 2019; 20(6): 842–858.
- Bomba-Opon D, Gutaj P, Kedzia M, et al. Guidelines of the Polish Society of Gynecologists and Obstetricians on the obstetric care of women with obesity. Ginekol Pol. 2023; 94(12): 1011–1029.
- Rogozińska E, Zamora J, Marlin N, et al. International Weight Management in Pregnancy (i-WIP) Collaborative Group. Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials. BMC Pregnancy Childbirth. 2019; 19(1): 322.
- Lauterbach R, Ben Zvi D, Dabaja H, et al. Vaginal Dinoprostone Insert versus Cervical Ripening Balloon for Term Induction of Labor in Obese Nulliparas-A Randomized Controlled Trial. J Clin Med. 2022; 11(8).
- Beckwith L, Magner K, Kritzer S, et al. Prostaglandin versus mechanical dilation and the effect of maternal obesity on failure to achieve active labor: a cohort study. J Matern Fetal Neonatal Med. 2017; 30(13): 1621–1626.
- Ashraf R, Maxwell C, D'Souza R. Induction of labour in pregnant individuals with obesity. Best Pract Res Clin Obstet Gynaecol. 2022; 79: 70–80.
- Eberle A, Czuzoj-Shulman N, Azoulay L, et al. Induction of labor at 39 weeks and risk of cesarean delivery among obese women: a retrospective propensity score matched study. J Perinat Med. 2021; 49(7): 791–796.
- Skibinska KA, Kolak M, Micek A, et al. Comparison of labor duration of induced labor with dinoprostone insert vs spontaneous labor. Ginekol Pol. 2023; 94(12): 984–989.
- Kolak M, Skibinska K, Rybak-Krzyszkowska M, et al. Influence of gestational diabetes mellitus on outcomes of preinduced labour with dinoprostone vaginal insert. Ginekol Pol. 2023 [Epub ahead of print].