Obesity in Pregnancy and Retrospective Analysis of Obesity in

Pregnancy
Faustina Prima Martha*, Erza Pinayungan** and Dhita Mutiara***
* Third Year Biological Engineering Student, Universitas Indonesia,
(faustina.martha@gmail.com)
** Second Year Medical Student, Universitas Indonesia, (erzapinayungan@gmail.com)
*** First Year Biology Student, Universitas Indonesia, (dhitamutiarana@gmail.com)

Abstract
Objectives : (1) To conduct a literature review and a retrospective analysis
of a cohort of New Zealand women. (2) To determine the relationship
between weight and complications in pregnancy. (3) To develop
knowledge and understanding of the relationship between the prepregnancy weight of a woman and complication and outcomes during the
antepartum, intrapartum and postpartum periods.
Method : The study design is a retrospective closed cohort study of 6174
eligible women who delivered in CDHB facilities between the 1st of March
2011 and 31 March 2012. The outcome measures were motivated by the
findings of the literature review whereby odds ratio values were calculated
in most instances to measure the magnitude of increased odds of
outcome of complication or adverse outcome in the antepartum,
intrapartum and postpartum periods, and of the neonate, compared to a
reference group that were defined by anthropometric measures
Result : 2,576 (54.1%) women were classified as underweight or normal,
1,263 (26.5%) as overweight, and 920 (19.3%) as obese. A number of
significant associated between body size and pregnancy complications
were identified.
Conclusion : Woman who has a higher than normal BMI index values prepregnancy had significantly increased odds of complications relating to a
number of outcomes compared to women with normal BMI index values.
Keywords : Obesity, Pregnancy, Retrospective Analysis, BMI, Complications.

M
overview

aternal
obesity
is
linked with adverse
outcomes for mothers
and babies. To get an
of risks related to

obesity in pregnant women, a

systematic review of reviews was
conducted. For inclusion, reviews
had to compare pregnant women
of healthy weight with women

with obesity, and measure a

health outcome for mother and/or
baby. Narrative analysis of the 22
reviews included show gestational
diabetes,
pre-eclampsia,
gestational
hypertension,
depression,
instrumental
and
caesarean birth, and surgical site
infection to be more likely to
occur in pregnant women with
obesity compared with women
with a healthy weight. Maternal
obesity is also linked to greater
risk of preterm birth, large-forgestational-age
babies,
foetal
defects, congenital anomalies and
perinatal death.

The information gathered in the

literature review determined the
scope
of
outcomes
and
complications to be examined
during the quantitative analysis
phase of this study. The analysis
focused on a large cohort of
women
who
delivered
in
Canterbury District Health Board
(CDHB) facilities to understand
and empirically determine the
magnitude of association between
overweight and obesity and
pregnancy
complications
and
adverse outcomes.
Methods
Data Collecting

Objective
The objective of this study was to
conduct a literature review and a
retrospective analysis of a cohort
of New Zealand women to
determine
the
relationship
between
weight
and
complications in pregnancy. The
literature review was undertaken
to
develop
knowledge
and
understanding of the relationship
between
the
pre-pregnancy
weight
of
a
woman
and
complication
and
outcomes
during
the
antepartum,
intrapartum
and
postpartum
periods. In addition, the review
sought
to
determine
complications and outcomes that
relate to the neonate in the
perinatal period. The review was
also means of identifying rates of
outcome in other populations,
relevant terms, definitions and
terminology.

An electronic literature search

was conducted through January
2016 by using NCBI website and
another related websites like :
PLOS, Online Wiley Lab, etc. The
search
of
medical
subject
headings included : Obesity,
Pregnancy, BMI, Complication,
Retrospective Analysis
Design of Quantitative Study,
Setting and Participants
The
study
design
is
a
retrospective closed cohort study
of 6174 eligible women who
delivered
in
CDHB
facilities
between the 1st of March 2011
and 31 March 2012. Some 4759
women were confirmed eligible,
as they had self-reported prepregnancy height and weight
available for analysis.

Main Outcome Measures

Results and Discussion

The outcome measures were

motivated by the findings of the
literature review whereby odds
ratio values were calculated in
most instances to measure the
magnitude of increased odds of
outcome
of
complication
or
adverse
outcome
in
the
antepartum,
intrapartum
and
postpartum periods, and of the
neonate, compared to a reference
group that were defined by
anthropometric measures. The
main anthropometric outcome
measure for body size was selfreported
pre-pregnancy
Body
Mass Index (BMI), calculated as
weight in kilograms divided by
height
in
meters
squared.
Analyses were stratified according
to BMI category and adjusted for
potential confounders that related
to demographics.

Overall, 2,576 (54.1%) women

were classified as underweight or
normal,
1,263
(26.5%)
as
overweight, and 920 (19.3%) as
obese. A number of significant
associated between body size and
pregnancy complications were
identified. Compared to women
classified as underweight or
normal,
obese
women
had
significantly increased adjusted
odds of an admission to an
obstetric
unit
during
the
gestational
period
due
to
complications (odds ratio (OR):
1.27 [95% CI: 1.07, 1.51]). There
are increased odds of a prolonged
pregnancy for women who were
classified as being overweight
(OR: 1.59 [95% CI: 1.22, 2.07]) or
obese (OR: 1.51 [95% CI: 1.12,
2.03])
compared
to
women
classified as being underweight or
normal.

In
the
intrapartum
period,
induction
of
labour
was
significantly related to body size
classification.
Compared
to
women classified as underweight
or normal, overweight (OR: 1.24,
[95% CI: 1.04, 1.47]) and obese
(OR: 1.40 [95% CI: 1.16, 1.69])
women had higher odds of being
induced. In addition there is
significantly increased odds of
requiring the caesarean delivery
to performed as an emergency
caesarean delivery; overweight

(OR: 1.29 [95% CI: 1.07, 1.56])

and obese (OR: 1.37 [95% CI:
1.12,
1.69])
classifications.
Consequently
there
is
an
increased likelihood of longer stay
in hospital post-delivery, for
overweight (OR: 1.28 [95% CI:
1.11, 1.47]) and obese (OR: 1.35,
[95% CI: 1.15, 1.58]) compared to
underweight or normal weight
women.
Crude analysis revealed women
with weight above normal limits
compared to women of normal

weight have increased odds of

delivering
a
baby
that
is
consequently diagnosed with a
respiratory
or
cardiovascular
condition; overweight (OR: 1.26
[95% CI: 1.01, 1.67]), obese (OR:
1.32 [95% CI: 1.04, 1.67]).
However, after adjusting for age,
ethnicity, delivery status and
smoking status, the significant
difference was lost.
Conclusion
Woman who has a higher than
normal BMI index values prepregnancy
had
significantly
increased odds of complications

relating to a number of outcomes

compared to women with normal
BMI index values. Significant
outcomes included: increased
odds
of
admission
during
pregnancy, induction of labour,
caesarean section, emergency
caesarean section, longer hospital
stays and risk to the neonate in
terms
of
respiratory
or
cardiovascular complications. The
increased
odds
of
adverse
outcomes not only increase the
risk burden for the patient and
offspring but presents additional
challenges for the providers of
obstetrics and neonatal care in
New Zealand.

Acknowledgement
The author acknowledges the
assistance of Winnie Yu, PharmD,
BCPS; Tara Cockerham, PharmD;
and Krista Yokoyama, PharmD, in
the development of this paper.

Disclosure
No outside funding supported this
study. Author Sheta Ara discloses
no bias or conflict of interest.

References
http://onlinelibrary.wiley.com/doi/10.1111/obr.12288/abstract
http://consultations.nhmrc.gov.au/files/consultations/lit_review_pbf_women-_for_consultation_dec_2011.pdf