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The influence of obesity and diabetes on the risk of cesarean delivery.
Am J Obstet Gynecol. 2004 Sep; 191(3):969-74.AJ

Abstract

OBJECTIVE

To determine the influence of pregravid obesity and diabetes on cesarean delivery (CD) risk.

STUDY DESIGN

Women with singleton pregnancies of 23 weeks or more estimated gestational age who were undergoing a trial of labor January 1997 through June 2001 were categorized by pregravid body mass index (underweight [<19.8 kg/m 2 ], normal [19.8-25 kg/m 2 ], overweight [25.1-30 kg/m2], obese [>30 kg/m2]). Diabetes (DM) was divided into categories of gestational, treated with diet modification (A1GDM) or insulin (A2GDM), and pregestational (PDM). Prior CDs were excluded. CD rates for each group were compared in univariate analyses stratified by estimated gestational age (term, preterm, total). Other variables examined included DM, macrosomia (birth weight 4500 g or more), induction, and parity. Multiple regression included significant variables to predict the influence of diabetes and obesity on CD risk.

RESULTS

Records for 12,303 deliveries were evaluated (obese: 2828 [22.9%]; overweight: 2605 [21.2%]; A1GDM: 270 [2.2%]; A2GDM: 93 [0.8%]; PDM: 126 [1%]). Obese and overweight subjects had a higher risk for CD, compared with normal subjects (13.8% and 10.4% versus 7.7%, P < .0001 for each). Other CD risk factors were macrosomia (25% versus 9.4%), nulliparity (16.5% versus 4.7%), induction (17.4% versus 8.3%), diabetes (A1GDM: 16.7% versus 9.4%; A2GDM: 24.7% versus 9.5%; PDM: 34.9% versus 9.3%) and black race (10.7% versus 8.8%) (P < .0001 for each). In multiple regression models including term deliveries, obesity and PDM were independent CD risk factors ([adjusted OR overweight: 1.5, P < .0001; adjusted OR PDM: 2.9, P = .01]; [adjusted OR obese: 2.4, P < .0001, PDM: 2.9, P = .0002]).

CONCLUSION

Pregravid obesity and diabetes independently increase the risk for CD. Given the disparate prevalence of obesity and diabetes in the United States, body habitus has a significantly larger impact on CD risk.

Authors+Show Affiliations

Case Western Reserve University School of Medicine, Department of Reproductive Biology, MetroHealth Medical Center, Cleveland, Ohio, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15467574

Citation

Ehrenberg, Hugh M., et al. "The Influence of Obesity and Diabetes On the Risk of Cesarean Delivery." American Journal of Obstetrics and Gynecology, vol. 191, no. 3, 2004, pp. 969-74.
Ehrenberg HM, Durnwald CP, Catalano P, et al. The influence of obesity and diabetes on the risk of cesarean delivery. Am J Obstet Gynecol. 2004;191(3):969-74.
Ehrenberg, H. M., Durnwald, C. P., Catalano, P., & Mercer, B. M. (2004). The influence of obesity and diabetes on the risk of cesarean delivery. American Journal of Obstetrics and Gynecology, 191(3), 969-74.
Ehrenberg HM, et al. The Influence of Obesity and Diabetes On the Risk of Cesarean Delivery. Am J Obstet Gynecol. 2004;191(3):969-74. PubMed PMID: 15467574.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The influence of obesity and diabetes on the risk of cesarean delivery. AU - Ehrenberg,Hugh M, AU - Durnwald,Celeste P, AU - Catalano,Patrick, AU - Mercer,Brian M, PY - 2004/10/7/pubmed PY - 2004/11/9/medline PY - 2004/10/7/entrez SP - 969 EP - 74 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 191 IS - 3 N2 - OBJECTIVE: To determine the influence of pregravid obesity and diabetes on cesarean delivery (CD) risk. STUDY DESIGN: Women with singleton pregnancies of 23 weeks or more estimated gestational age who were undergoing a trial of labor January 1997 through June 2001 were categorized by pregravid body mass index (underweight [<19.8 kg/m 2 ], normal [19.8-25 kg/m 2 ], overweight [25.1-30 kg/m2], obese [>30 kg/m2]). Diabetes (DM) was divided into categories of gestational, treated with diet modification (A1GDM) or insulin (A2GDM), and pregestational (PDM). Prior CDs were excluded. CD rates for each group were compared in univariate analyses stratified by estimated gestational age (term, preterm, total). Other variables examined included DM, macrosomia (birth weight 4500 g or more), induction, and parity. Multiple regression included significant variables to predict the influence of diabetes and obesity on CD risk. RESULTS: Records for 12,303 deliveries were evaluated (obese: 2828 [22.9%]; overweight: 2605 [21.2%]; A1GDM: 270 [2.2%]; A2GDM: 93 [0.8%]; PDM: 126 [1%]). Obese and overweight subjects had a higher risk for CD, compared with normal subjects (13.8% and 10.4% versus 7.7%, P < .0001 for each). Other CD risk factors were macrosomia (25% versus 9.4%), nulliparity (16.5% versus 4.7%), induction (17.4% versus 8.3%), diabetes (A1GDM: 16.7% versus 9.4%; A2GDM: 24.7% versus 9.5%; PDM: 34.9% versus 9.3%) and black race (10.7% versus 8.8%) (P < .0001 for each). In multiple regression models including term deliveries, obesity and PDM were independent CD risk factors ([adjusted OR overweight: 1.5, P < .0001; adjusted OR PDM: 2.9, P = .01]; [adjusted OR obese: 2.4, P < .0001, PDM: 2.9, P = .0002]). CONCLUSION: Pregravid obesity and diabetes independently increase the risk for CD. Given the disparate prevalence of obesity and diabetes in the United States, body habitus has a significantly larger impact on CD risk. SN - 0002-9378 UR - https://www.unboundmedicine.com/medline/citation/15467574/The_influence_of_obesity_and_diabetes_on_the_risk_of_cesarean_delivery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S000293780400657X DB - PRIME DP - Unbound Medicine ER -