title: Obesity, comorbidities, and the cesarean delivery rate.
abstract: OBJECTIVE
  To evaluate the effect of comorbidities and induction of labor (IOL) on the cesarean delivery (CD) rate in an obese nulliparous cohort.
  
  
  METHODS
  This was a retrospective review of medical records of patients who delivered at our institution from January 1, 2010, to January 18, 2011. Nulliparous patients were identified with a body mass index of ≥ 30.0 kg/m2. The rates of IOL and CD for patients with a comorbidity were compared with those patients without a comorbidity.
  
  
  RESULTS
  Among 1908 patients, 105 met inclusion criteria. The CD rate was significantly higher in the comorbid group (58.5%) than in the control group (34.6%) [odds ratio (OR) 2.66, 95% confidence interval (CI) 1.21 to 5.87, p = 0.019] [corrected].The IOL rate was significantly higher in the comorbid group (71.7% versus 15.4%; OR 13.93, 95% CI 5.33 to 36.46, p < 0.0001). Preeclampsia (44.7%) was the most common indication for IOL in the comorbid group, whereas postterm pregnancy (50%) was the most common indication in the control group.
  
  
  CONCLUSIONS
  The CD rate in obese women with comorbidities is higher than that of obese women without comorbidity. These results suggest that the higher IOL rate and subsequent failed induction in obese women with comorbidities is a significant factor contributing to this association.
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, UMDNJ (University of Medicine and Dentistry, New Jersey), New Jersey Medical School, Newark, New Jersey 07101, USA. rudysuidan@gmail.com
authors.forename: Rudy S
authors.initials: RS
authors.lastname: Suidan
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Apuzzio
authors.forename: Shauna F
authors.initials: SF
authors.lastname: Williams
mesh_terms: D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology; D011247:Pregnancy; D012189:Retrospective Studies