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Interpregnancy body mass index change and success of term vaginal birth after cesarean delivery.
Am J Obstet Gynecol 2014; 210(4):330.e1-330.e7AJ

Abstract

OBJECTIVE

We investigated the effect of interpregnancy body mass index (BMI) change on success of term vaginal birth after cesarean (VBAC) among normal, overweight and obese women.

STUDY DESIGN

Using 1992-2009 Washington State birth certificate data linked with hospitalization records, we conducted a population-based retrospective cohort study of nulliparous women (BMI ≥18.5 kg/m(2)) with a primary cesarean in their first birth and a term trial of labor in their second. Interpregnancy weight change (difference between first and second prepregnancy BMIs) was categorized as maintenance (<1 BMI unit change), loss (≥1 unit), moderate gain (≥1 and <2 units), high gain (≥2 units). We estimated relative risks of VBAC success using generalized linear models with a log-link function, adjusting for maternal age, race/ethnicity, nativity, marital status, education, smoking, primary cesarean indication, interpregnancy interval, birth year for second birth, and prenatal care adequacy.

RESULTS

Among 8302 women who attempted a term trial of labor, 65% had a successful VBAC. Women with normal BMI before their first pregnancy experienced an 8% decrease in VBAC success with moderate gain (relative risk [RR], 0.92; 95% confidence interval [CI], 0.87-0.98) and a 12% decrease in success with high gain (RR, 0.88; 95% CI, 0.83-0.93), compared with normal weight women who maintained weight. Weight loss increased VBAC success in women who were overweight (RR, 1.12; 95% CI, 1.01-1.25) or obese before their first delivery (RR, 1.24; 95% CI, 1.04-1.49), compared with overweight and obese women, respectively, who maintained weight.

CONCLUSION

Women can improve their chance of successful VBAC through interpregnancy weight management.

Authors+Show Affiliations

Department of Epidemiology, University of Washington School of Public Health, Seattle, WA; Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA; Health Services Research and Development, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA. Electronic address: lcallega@uw.edu.Department of Epidemiology, University of Washington School of Public Health, Seattle, WA.Department of Epidemiology, University of Washington School of Public Health, Seattle, WA.Department of Epidemiology, University of Washington School of Public Health, Seattle, WA.Department of Epidemiology, University of Washington School of Public Health, Seattle, WA; Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24215856

Citation

Callegari, Lisa S., et al. "Interpregnancy Body Mass Index Change and Success of Term Vaginal Birth After Cesarean Delivery." American Journal of Obstetrics and Gynecology, vol. 210, no. 4, 2014, pp. 330.e1-330.e7.
Callegari LS, Sterling LA, Zelek ST, et al. Interpregnancy body mass index change and success of term vaginal birth after cesarean delivery. Am J Obstet Gynecol. 2014;210(4):330.e1-330.e7.
Callegari, L. S., Sterling, L. A., Zelek, S. T., Hawes, S. E., & Reed, S. D. (2014). Interpregnancy body mass index change and success of term vaginal birth after cesarean delivery. American Journal of Obstetrics and Gynecology, 210(4), pp. 330.e1-330.e7. doi:10.1016/j.ajog.2013.11.013.
Callegari LS, et al. Interpregnancy Body Mass Index Change and Success of Term Vaginal Birth After Cesarean Delivery. Am J Obstet Gynecol. 2014;210(4):330.e1-330.e7. PubMed PMID: 24215856.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interpregnancy body mass index change and success of term vaginal birth after cesarean delivery. AU - Callegari,Lisa S, AU - Sterling,Lauren A, AU - Zelek,Sarah T, AU - Hawes,Stephen E, AU - Reed,Susan D, Y1 - 2013/11/08/ PY - 2013/08/07/received PY - 2013/10/10/revised PY - 2013/11/04/accepted PY - 2013/11/13/entrez PY - 2013/11/13/pubmed PY - 2014/5/21/medline KW - VBAC KW - body mass index KW - interpregnancy weight change KW - obesity KW - vaginal birth after cesarean SP - 330.e1 EP - 330.e7 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 210 IS - 4 N2 - OBJECTIVE: We investigated the effect of interpregnancy body mass index (BMI) change on success of term vaginal birth after cesarean (VBAC) among normal, overweight and obese women. STUDY DESIGN: Using 1992-2009 Washington State birth certificate data linked with hospitalization records, we conducted a population-based retrospective cohort study of nulliparous women (BMI ≥18.5 kg/m(2)) with a primary cesarean in their first birth and a term trial of labor in their second. Interpregnancy weight change (difference between first and second prepregnancy BMIs) was categorized as maintenance (<1 BMI unit change), loss (≥1 unit), moderate gain (≥1 and <2 units), high gain (≥2 units). We estimated relative risks of VBAC success using generalized linear models with a log-link function, adjusting for maternal age, race/ethnicity, nativity, marital status, education, smoking, primary cesarean indication, interpregnancy interval, birth year for second birth, and prenatal care adequacy. RESULTS: Among 8302 women who attempted a term trial of labor, 65% had a successful VBAC. Women with normal BMI before their first pregnancy experienced an 8% decrease in VBAC success with moderate gain (relative risk [RR], 0.92; 95% confidence interval [CI], 0.87-0.98) and a 12% decrease in success with high gain (RR, 0.88; 95% CI, 0.83-0.93), compared with normal weight women who maintained weight. Weight loss increased VBAC success in women who were overweight (RR, 1.12; 95% CI, 1.01-1.25) or obese before their first delivery (RR, 1.24; 95% CI, 1.04-1.49), compared with overweight and obese women, respectively, who maintained weight. CONCLUSION: Women can improve their chance of successful VBAC through interpregnancy weight management. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/24215856/Interpregnancy_body_mass_index_change_and_success_of_term_vaginal_birth_after_cesarean_delivery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(13)02012-7 DB - PRIME DP - Unbound Medicine ER -