Maternal and perinatal outcome in obese pregnant patients.
Sommaire de l'article
INTRODUCTION: Obesity represents a rapidly emerging epidemic amongst pregnant patients in South Australia, in particular in Adelaide’s Northern suburbs, one of the poorest urban areas in Australia. The aim of the current study was to prepare a comprehensive overview of maternal and perinatal outcome in overweight, obese and morbidly obese pregnant patients. MATERIAL AND METHODS: Retrospective review of women with singleton pregnancies delivering in the first 6 months of 2006; 100 with normal BMI (group I: BMI 19.1-25 kg/m(2)), 100 overweight (group II: BMI 25.1-30 kg/m(2)), 110 obese (group III: BMI 30.1-40 kg/m(2)) and 60 morbidly obese women (group IV: BMI >40 kg/m(2)) were identified with access to complete medical records. Outcome measures included booking demographics, booking blood pressures, glucose challenge and glucose tolerance results, hypertensive complications, pre-existing and gestational diabetes, instrumental deliveries, caesarean deliveries, blood loss, birth weights, Apgar scores, post-partum complications and psychological problems. RESULTS: Women in group II, III and IV were characterised by higher systolic booking blood pressure (mean differences: 3.92, 9.94 and 9.84 respectively for group II, III and IV) and higher diastolic booking blood pressures (mean differences 3.02, 6.92 and 9.22 respectively). As a combined group II-IV, women were at increased risk for pre-existing morbidity (OR 2.33) and requiring medication (OR 2.13). Pregnancy hypertension occurred significantly more in group III and IV with OR 2.38 and 3.75. Women without pre-existing hypertension were also found to be at increased risk to develop gestational hypertension only if they belonged to group IV (OR 3.69). Women in group III and IV are at increased risk at gestational diabetes with OR 8.82 and 27.38. Women in group III and IV are less likely to have a spontaneous onset of labour with ORs of 2.18 and 3.51 for not having spontaneous onset of labour. Induction of labour occurred more often in group IV (OR 3.17). Requirement of instrumental deliveries or lower segment caesarean section occurred more often in group II, III and IV with OR 2.20, 3.28 and 5.47 respectively. Significant more blood loss was found in group III and IV with mean differences of 135.42 and 207.94 ml compared with group I. The birthweight in group III and IV are significantly higher with mean differences of 104.86 and 324.94 g. Macrosomia occurred more often in group IV (OR 4.04). Women in group III and IV had a longer overall hospital stay with mean differences of 0.58 and 1.09 days. Mental health issues were more common in group II, III and IV with OR 3.16, 3.53 and 4.17 respectively. CONCLUSION: These South Australian data from a socio-economically deprived area in Adelaide’s Northern suburbs confirm that obesity during pregnancy represents a major risk for adverse outcome for patients with a whole spectrum of adverse pregnancy outcomes; obesity represents a major challenge for health care providers.