Maternal obesity and risk of cesarean delivery: a meta-analysis.
Despite numerous studies reporting an increased risk of cesarean delivery among overweight or obese compared with normal weight women, the magnitude of the association remains uncertain. Therefore, we conducted a meta-analysis of the current literature to provide a quantitative estimate of this association. We identified studies from three sources: (i) a PubMed search of relevant articles published between January 1980 and September 2005; (ii) reference lists of publications selected from the search; and (iii) reference lists of review articles published between 2000 and 2005. We included cohort designed studies that reported obesity measures reflecting pregnancy body mass, had a normal weight comparison group, and presented data allowing a quantitative measurement of risk. We used a Bayesian random effects model to perform the meta-analysis and meta-regression. Thirty-three studies were included. The unadjusted odd ratios of a cesarean delivery were 1.46 [95% confidence interval (CI): 1.34-1.60], 2.05 (95% CI: 1.86-2.27) and 2.89 (95% CI: 2.28-3.79) among overweight, obese and severely obese women, respectively, compared with normal weight pregnant women. The meta-regression found no evidence that these estimates were affected by selected study characteristics. Our findings provide a quantitative estimate of the risk of cesarean delivery associated with high maternal body mass.
Chu
S Y
SY
Division of Reproductive Health, Centers for Disease Control and Prevention, Mailstop K23, 1600 Clifton Road, Atlanta, GA 30333, USA. syc1@cdc.gov
Kim
S Y
SY
Schmid
C H
CH
Dietz
P M
PM
Callaghan
W M
WM
Lau
J
J
Curtis
K M
KM
D000328:Adult; D001499:Bayes Theorem; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D009765:Obesity / Q000150:complications*; D007744:Obstetric Labor Complications / Q000209:etiology* / Q000601:surgery; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D018570:Risk Assessment; D012307:Risk Factors