TY - JOUR
T1 - Binational cohort study comparing the management and outcomes of pregnant women with a BMI >50–59.9 kg/m2and those with a BMI ≥60 kg/m2
AU - McCall, Stephen J
AU - Li, Zhuoyang
AU - Kurinczuk, Jennifer J
AU - Sullivan, Elizabeth
AU - Knight, Marian
N1 - Funding SJM is funded by the Nuffield Department of Population Health and
Medical Research Council (MRC) training grant MR/K501256/1. MK is funded by an
NIHR Research Professorship. The National Health and Medical Research Council
Project Grant (Application 510298) funded The Australasian Maternity Outcomes
Surveillance System : Improving safety and quality of maternity care in Australia
(AMOSS) from 2008 to 2012.
Acknowledgments
We thank the Australasian Maternity Outcomes Surveillance System advisory group and UK Obstetric Surveillance System steering committee for their input into the respective obesity studies. Dr Bryn Kemp and Dr Manisha Nair for their advice.
PY - 2018/8/10
Y1 - 2018/8/10
N2 - Objectives To compare the management, maternal and perinatal outcomes of women with a body mass index (BMI) ≥60 kg/m2 with women with a BMI >50–59.9 kg/m2.Design International collaborative cohort study.Setting Binational study in the UK and Australia.Participants UK: all pregnant women, and Australia: women who gave birth (birth weight ≥400 g or gestation ≥20 weeks)Methods Data from the Australasian Maternity Outcomes Surveillance System and UK Obstetric Surveillance System. Management, maternal and infant outcomes were compared between women with a BMI ≥60 kg/m2 and women with a BMI >50–59.9 kg/m2, using unconditional logistic regression.Results The sociodemographic characteristics and previous medical histories were similar between the 111 women with a BMI ≥60 kg/m2 and the 821 women with a BMI >50–59.9 kg/m2. Women with a BMI ≥60 kg/m2 had higher odds of thromboprophylaxis usage in both the antenatal (24% vs. 12%; OR 2.25, 95% CI 1.39 to 3.64) and postpartum periods (78% vs. 66%; OR 1.68, 95% CI 1.04 to 2.70). Women with BMI ≥60 kg/m2 had nearly double the odds of pre-eclampsia/eclampsia (adjusted OR 1.83 (95% CI 1.01 to 3.30)). No other maternal or perinatal outcomes were statistically significantly different. Severe adverse outcomes such as perinatal death were uncommon in both groups thus limiting the power of these comparisons. The rate of perinatal deaths was 18 per 1000 births for those with BMI ≥60 kg/m2; 12 per 1000 births for those with BMI >50–59.9 kg/m2; those with BMI ≥60 kg/m2 had a non-significant increased odds of perinatal death (unadjusted OR 1.46, 95% CI 0.31 to 6.74).Conclusions Women are managed differently on the basis of BMI even at this extreme as shown by thromboprophylaxis. The pre-eclampsia result suggests that future research should examine whether weight reduction of any amount prior to pregnancy could reduce poor outcomes even if women remain extremely obese.
AB - Objectives To compare the management, maternal and perinatal outcomes of women with a body mass index (BMI) ≥60 kg/m2 with women with a BMI >50–59.9 kg/m2.Design International collaborative cohort study.Setting Binational study in the UK and Australia.Participants UK: all pregnant women, and Australia: women who gave birth (birth weight ≥400 g or gestation ≥20 weeks)Methods Data from the Australasian Maternity Outcomes Surveillance System and UK Obstetric Surveillance System. Management, maternal and infant outcomes were compared between women with a BMI ≥60 kg/m2 and women with a BMI >50–59.9 kg/m2, using unconditional logistic regression.Results The sociodemographic characteristics and previous medical histories were similar between the 111 women with a BMI ≥60 kg/m2 and the 821 women with a BMI >50–59.9 kg/m2. Women with a BMI ≥60 kg/m2 had higher odds of thromboprophylaxis usage in both the antenatal (24% vs. 12%; OR 2.25, 95% CI 1.39 to 3.64) and postpartum periods (78% vs. 66%; OR 1.68, 95% CI 1.04 to 2.70). Women with BMI ≥60 kg/m2 had nearly double the odds of pre-eclampsia/eclampsia (adjusted OR 1.83 (95% CI 1.01 to 3.30)). No other maternal or perinatal outcomes were statistically significantly different. Severe adverse outcomes such as perinatal death were uncommon in both groups thus limiting the power of these comparisons. The rate of perinatal deaths was 18 per 1000 births for those with BMI ≥60 kg/m2; 12 per 1000 births for those with BMI >50–59.9 kg/m2; those with BMI ≥60 kg/m2 had a non-significant increased odds of perinatal death (unadjusted OR 1.46, 95% CI 0.31 to 6.74).Conclusions Women are managed differently on the basis of BMI even at this extreme as shown by thromboprophylaxis. The pre-eclampsia result suggests that future research should examine whether weight reduction of any amount prior to pregnancy could reduce poor outcomes even if women remain extremely obese.
UR - https://doi.org/10.1136/bmjopen-2017-021055
U2 - 10.1136/bmjopen-2017-021055
DO - 10.1136/bmjopen-2017-021055
M3 - Article
VL - 8
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 8
M1 - e021055
ER -