Examining the effect of maternal obesity on outcome of labor induction in patients with preeclampsia.
OBJECTIVE
The objective of this investigation was to evaluate the effect of maternal obesity, as measured by prepregnancy body mass index (BMI), on the mode of delivery in women undergoing indicated induction of labor for preeclampsia.


METHODS
Following Institutional Review Board (IRB) approval, patients with preeclampsia who underwent an induction of labor from 1997 to 2007 were identified from a perinatal information database, which included historical and clinical information. Data analysis included bivariable and multivariable analyses of predictor variables by mode of delivery. An artificial neural network was trained and externally validated to independently examine predictors of mode of delivery among women with preeclampsia.


RESULTS
Six hundred and eight women met eligibility criteria and were included in this investigation. Based on multivariable logistic regression (MLR) modeling, a 5-unit increase in BMI yields a 16% increase in the odds of cesarean delivery. An artificial neural network trained and externally validated confirmed the importance of obesity in the prediction of mode of delivery among women undergoing labor induction for preeclampsia.


CONCLUSIONS
Among patients who are affected by preeclampsia, obesity complicates labor induction. The risk of cesarean delivery is enhanced by obesity, even with small increases in BMI. Prediction of mode of delivery by an artificial neural network performs similar to MLR among patients undergoing labor induction for preeclampsia.
Robinson
Christopher J
CJ
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina 29425, USA. robinscj@musc.edu
Hill
Elizabeth G
EG
Alanis
Mark C
MC
Chang
Eugene Y
EY
Johnson
Donna D
DD
Almeida
Jonas S
JS
D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007751:Labor, Induced; D009765:Obesity; D011225:Pre-Eclampsia; D011247:Pregnancy; D012372:ROC Curve; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome
NCHS Data Brief. 2007 Nov;(1):1-8
19389313
Am J Obstet Gynecol. 1998 Nov;179(5):1210-3
9822502
Natl Vital Stat Rep. 2006 Sep 29;55(1):1-101
17051727
Am J Obstet Gynecol. 1998 Jun;178(6):1207-14
9662303
Acta Obstet Gynecol Scand. 2002 Sep;81(9):867-9
12225304
Curr Opin Biotechnol. 2002 Feb;13(1):72-6
11849962
Obstet Gynecol Clin North Am. 1999 Jun;26(2):275-86
10399761
Am J Obstet Gynecol. 1976 Nov 1;126(5):555-64
984126
Obstet Gynecol. 1997 Apr;89(4):600-3
9083320
Am J Perinatol. 2008 Mar;25(3):163-7
18300188
Lancet. 2005 Feb 26-Mar 4;365(9461):785-99
15733721
Obstet Gynecol. 2007 Feb;109(2 Pt 1):270-6
17267823
Hypertension. 2005 Dec;46(6):1243-9
16230510
Am J Obstet Gynecol. 2008 Aug;199(2):193.e1-6
18533119
Ann Epidemiol. 2005 Aug;15(7):475-82
16029839
J Biomed Inform. 2002 Oct-Dec;35(5-6):352-9
12968784
N Engl J Med. 1998 Jan 15;338(3):147-52
9428815
Epidemiology. 2007 Mar;18(2):234-9
17237733
BMC Public Health. 2007 Jul 24;7:168
17650297
J Obstet Gynaecol Can. 2008 Jun;30(6):477-488
18611299
Gynecol Obstet Invest. 2006;61(1):40-4
16179789
BJOG. 2005 Apr;112(4):403-8
15777435
Am J Obstet Gynecol. 1998 Nov;179(5):1275-8
9822515
Br J Obstet Gynaecol. 1987 Jan;94(1):55-9
3814556
Obstet Gynecol. 2002 Jan;99(1):159-67
16175681
Obstet Gynecol. 2007 Oct;110(4):801-7
17906012
Int J Gynaecol Obstet. 2006 Dec;95(3):242-7
17007857
Obes Rev. 2007 Sep;8(5):385-94
17716296
Birth. 2007 Mar;34(1):53-64
17324180
JAMA. 2002 May 22-29;287(20):2684-90
12020304
NIH Consens State Sci Statements. 2006 Mar 27-29;23(1):1-29
17308552
Epidemiology. 2006 Jul;17(4):428-34
16755262
Am J Nurs. 2006 Jan;106(1):40-9, quiz 49-50
16481779
Br J Anaesth. 1991 Sep;67(3):306-9
1911018