Does increasing body mass index affect cerclage efficacy?
OBJECTIVE
To study the relationship between body mass index (BMI) and gestational age (GA) at delivery in patients with cervical insufficiency (CI) undergoing cerclage.


METHODS
We accessed a database of patients with singleton gestations undergoing cerclage (N=168) for a well-characterized history of CI, shortened cervix <2.5 cm with a history of prior preterm delivery or prolapse of membranes through the external os. Univariate and multivariate logistic regression analysis were performed to compare obstetrical outcomes between obese and normal-weight patients.


RESULTS
Prior preterm delivery <35 weeks in obese vs normal-weight patients was significantly higher (44% vs 9%), odds ratio=6.9 (95% CI: 2.5, 18.5), with lower mean GA at delivery (32.6±7.0 vs 37.2±3.4 weeks, P<0.001). After controlling for confounders, BMI remained significantly predictive of prematurity (coefficient: -0.12, adjusted R (2)=0.24), such that every additional 1 unit of BMI was associated with a 1-day reduction in GA at delivery (P=0.03).


CONCLUSIONS
An inverse correlation exists between BMI and GA at delivery in patients with CI receiving cerclage. The findings are unexpected given the protective effect of obesity on spontaneous preterm delivery.
Perinatal Diagnostic Center, Inova Alexandria Hospital, Alexandria, VA 22304, USA. sarah.poggi@inova.org
S H
SH
Poggi
N A
NA
Vyas
J C
JC
Pezzullo
H J
HJ
Landy
A
A
Ghidini
D000328:Adult; D015992:Body Mass Index; D023802:Cerclage, Cervical / Q000379:methods*; D002584:Cervix Uteri / Q000601:surgery*; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D016015:Logistic Models; D009765:Obesity / Q000150:complications* / Q000601:surgery; D007752:Obstetric Labor, Premature / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000601:surgery*; D055815:Young Adult