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

Stephen J McCall; Zhuoyang Li; Jennifer J Kurinczuk; Elizabeth Sullivan; Marian Knight

doi:10.1136/bmjopen-2017-021055

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

Stephen J McCall^* (Corresponding Author), Zhuoyang Li, Jennifer J Kurinczuk, Elizabeth Sullivan, Marian Knight

^*Corresponding author for this work

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Abstract

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.

Original language	English
Article number	e021055
Number of pages	8
Journal	BMJ Open
Volume	8
Issue number	8
DOIs	https://doi.org/10.1136/bmjopen-2017-021055
Publication status	Published - 10 Aug 2018

Bibliographical note

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.

Data Availability Statement

The NPEU Data sharing agreement can be found here:
https://www.npeu.ox.ac.uk/downloads/files/npeu/policies/DataSharingPolicy.pdf.
Access to the Australian data must be made to the AMOSS steering committee.

Access to Document

10.1136/bmjopen-2017-021055Licence: CC BY

McCall_etal_BMJ_Binational_Cohort_Study_VoR
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/ licenses/by/4.0/. The NPEU Data sharing agreement can be found here: https://www.npeu.ox.ac.uk/downloads/files/npeu/policies/DataSharingPolicy.pdf. Access to the Australian data must be made to the AMOSS steering committee.
Licence: CC BY

Cite this

@article{fb431ace1a7f4eacb88acddcab69b79a,

title = "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",

abstract = "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.",

author = "McCall, {Stephen J} and Zhuoyang Li and Kurinczuk, {Jennifer J} and Elizabeth Sullivan and Marian Knight",

note = "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.",

year = "2018",

month = aug,

day = "10",

doi = "10.1136/bmjopen-2017-021055",

language = "English",

volume = "8",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "8",

}

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

SN - 2044-6055

VL - 8

JO - BMJ Open

JF - BMJ Open

IS - 8

M1 - e021055

ER -

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

Abstract

Bibliographical note

Data Availability Statement

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