The impact of obesity on maternal morbidity and feto-infant outcomes among macrosomic infants.
OBJECTIVE
To estimate the contribution of obesity to maternal complications, neonatal morbidity and mortality among macrosomic births.


METHODS
A population-based retrospective cohort design using State of Missouri maternally linked birth cohort files.


METHODS
Using pre-gravid body mass index (BMI), we categorized mothers of 116,976 singleton macrosomic live births as non-obese (BMI < 30) or obese (BMI ≥ 30). We used logistic regression models to generate adjusted odd ratios for pregnancy and neonatal complications. We also estimated the proportion of potentially preventable excess maternal and neonatal complications that could be eliminated among obese women with infant macrosomia at various levels of pre-pregnancy obesity reduction.


RESULTS
Obese mothers with macrosomic infants were at elevated risk for chronic hypertension (odds ratio (OR) = 6.78 [95% confidence interval (CI): 5.82-7.88]), insulin-dependent diabetes mellitus, (OR = 2.60 [CI: 2.34-2.88]) other types of diabetes mellitus (OR = 2.83 [CI: 2.65-3.02]) and preeclampsia (OR = 2.49 [CI: 2.33-2.67]). Macrosomic infants of obese mothers were at greater risk for hyaline membrane disease (OR = 2.14 [CI: 1.73-2.66]), extended assisted ventilation (OR = 1.71 [CI: 1.44-2.04]), birth injury (OR = 1.58 [CI: 1.37-1.84]) and meconium aspiration syndrome (OR = 1.42 [CI: 1.09-1.87]). The proportion of preventable excess maternal morbidity was 60%, 45%, 30% and 15%, assuming an effective pre-conception intervention that could reduce obesity down to 0%, 25%, 50% and 75% of its current level, respectively. The corresponding proportion of preventable excess neonatal complications would be 40%, 30%, 20% and 10%, respectively.


CONCLUSIONS
Among obese mothers with macrosomic births, a substantial proportion of maternal and neonatal morbidity could be averted through effective pre-conception interventions.
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of South Florida, Tampa, FL, USA. hamisu.salihu@gmail.com
Hamisu M
HM
Salihu
Hanna E
HE
Weldeselasse
Kiran
K
Rao
Phillip J
PJ
Marty
Valerie E
VE
Whiteman
D000328:Adult; D000465:Algorithms; D015331:Cohort Studies; D005260:Female; D005315:Fetal Diseases / Q000453:epidemiology / Q000209:etiology; D005320:Fetal Macrosomia / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008923:Missouri / Q000453:epidemiology; D009017:Morbidity; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000209:etiology; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D055815:Young Adult