Maternal Obesity Increases the Risk of Primary as Well as Secondary Caesarean Section

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Maternal obesity is not only associated with pregnancy outcome but also with the mode of delivery. In the present study the impact of maternal prepregnancy weight status on the mode of delivery, in particular on caesarean section rate was tested. The data of 3451 live births taking place at the Viennese University Hospital were analyzed. Maternal somatometrics (height, weight, weight gain) and newborn somatic characteristics (birth weight, birth length, head dimensions, APGAR scores) were documented. Prepregnancy weight status was classified using Body Mass Index (BMI) categories published by the WHO. The caesarean section rate was 15.6%. (6.8% primary CS, 8.8% secondary CS). 24.2% of the mothers were overweight, 9.6% obese and 0.8% morbidly obese before pregnancy. Maternal prepregnancy BMI was significantly associated with newborn size. The relative risk to give birth to a macrosome newborn was significantly increased among overweight (OR 1.46 CI 1.24-1.72), obese (OR 1.76 CI 1.40-2.19) and morbidly obese mothers (OR 1.51 CI 0.57-3.99). The relative risk of caesarean section increased significantly with increasing prepregnancy weight status (p<0.04). Morbidly obese women showed the significantly highest rate of caesarean section (33.4%; primary CS 16.7%, secondary CS 16.7%). The relative risk of experiencing caesarean section was significantly higher among morbidly obese women than among underweight (OR 3.57 CI 1.85-6.86), normal weight (OR 2.89 CI 1.25-6.69), overweight (OR 2.27 CI 0.99-5-22) and even obese women (OR 2.11 CI 0.94-4.72). Prepregnancy obesity is clearly a significant risk factor of newborn macrosomia and primary as well as secondary caesarean section.

The prevalence of overweight and obesity as a worldwide epidemic has increased dramatically since the beginning of the 21rst century. In 2008 for the first time in the long history of Homo sapiens, the number of obese people on earth exceeded the number of people who suffer from starvation and malnutrition. Currently more than 1.9 billion adults, 18 years and older, were overweight. Of these over 600 million correspond to the definition of obesity. From the viewpoint of public health this high prevalence of overweight and obesity is a major concern because overweight and especially obesity increase rates of metabolic diseases such as diabetes type II, cardiovascular diseases such as heart disease, stroke, hypertension, but also pancreatitis, osteoarthritis and cancer. Obesity however, is also related to reproductive problems, such as increased infertility rates in women as well as in men. A special problem represents obesity among women of reproductive age. In the United States more than 50% of women ageing between 20 and 39 years are overweight or obese. Europe seems to follow a similar pattern, albeit with some delay. Currently one in five pregnant women can be classified as obese in Europe.