title: Maternal outcomes in pregnancies complicated by obesity.
abstract: OBJECTIVE
  To investigate the relationship between prepregnancy obesity and maternal outcomes.
  
  
  METHODS
  A 15-year, population-based cohort study using the Nova Scotia Atlee Perinatal Database compared maternal outcomes in obese and nonobese women. Prepregnancy weight of 55-75 kg was considered nonobese, and weight greater than 90 kg was considered obese. Obese women were categorized into moderate obesity (90-120 kg) and severe obesity (> 120 kg) groups. Univariate and multivariable logistic regression analysis was performed, and odds ratios (ORs), adjusted ORs, and 95% confidence intervals (CIs) were calculated. P < .05 was considered statistically significant.
  
  
  RESULTS
  In 142,404 singleton pregnancies, 10,134 (7.2%) women were identified as obese (moderate obesity 92.3%, severe obesity 7.7%). The proportion of women in the obese categories increased from 3.2% in 1988 to 10.2% in 2002. Moderately obese women had an increased risk of pregnancy-induced hypertension (PIH) (adjusted OR 2.38, 95% CI 2.24-2.52), antepartum venous thromboembolism (adjusted OR 2.17, 95% CI 1.30-3.63), labor induction (adjusted OR 1.94, 95% CI 1.86-2.04), cesarean delivery (adjusted OR 1.60, 95% CI 1.53-1.67), and wound infection (adjusted OR 1.67, 95% CI 1.38-2.00). Severely obese women had an increased risk of PIH (adjusted OR 3.00, 95% CI 2.49-3.62), antepartum venous thromboembolism (adjusted OR 4.13, 95% CI 1.26-13.54), induction of labor (adjusted OR 2.77, 95% CI 2.39-3.21), cesarean delivery (adjusted OR 2.46, 95% CI 2.15-2.81), anesthesia complications (adjusted OR 2.01, 95% CI 1.33-3.06), and wound infection (adjusted OR 4.79, 95% CI 3.30-6.95). This implies that, relative to nonobese women, there was 1 excess case of PIH per 10 moderately obese women and 1 per 7 severely obese women. For antepartum venous thromboembolism, there was 1 excess case per 857 moderately obese women and 1 per 321 severely obese women.
  
  
  CONCLUSIONS
  Prepregnancy maternal obesity increases the risk of PIH, antepartum venous thromboembolism, labor induction, cesarean delivery, and wound infection.
authors.affiliation: Department of Obstetrics and Gynaecology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada. heatherrobinson10@yahoo.ca
authors.forename: Heather E
authors.initials: HE
authors.lastname: Robinson
authors.forename: Colleen M
authors.initials: CM
authors.lastname: O'Connell
authors.forename: K S
authors.initials: KS
authors.lastname: Joseph
authors.forename: N Lynne
authors.initials: NL
authors.lastname: McLeod
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015992:Body Mass Index; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D009674:Nova Scotia / Q000453:epidemiology; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology*; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index