title: Elevated maternal lipids in early pregnancy are not associated with risk of intrapartum caesarean in overweight and obese nulliparous women.
abstract: BACKGROUND
  Maternal overweight and obesity are associated with slower labour progress and increased caesarean delivery for failure to progress. Obesity is also associated with hyperlipidaemia and cholesterol inhibits myometrial contractility in vitro. Our aim was, among overweight and obese nulliparous women, to investigate 1. the role of early pregnancy serum cholesterol and 2. clinical risk factors associated with first stage caesarean for failure to progress at term.
  
  
  METHODS
  Secondary data analysis from a prospective cohort of overweight/obese New Zealand and Australian nullipara recruited to the SCOPE study. Women who laboured at term and delivered vaginally (n=840) or required first stage caesarean for failure to progress (n=196) were included. Maternal characteristics and serum cholesterol at 14-16 weeks' of gestation were compared according to delivery mode in univariable and multivariable analyses (adjusted for BMI, maternal age and height, obstetric care type, induction of labour and gestation at delivery ≥41 weeks).
  
  
  RESULTS
  Total cholesterol at 14-16 weeks was not higher among women requiring first stage caesarean for failure to progress compared to those with vaginal delivery (5.55 ± 0.92 versus 5.67 ± 0.85 mmol/L, p= 0.10 respectively). Antenatal risk factors for first stage caesarean for failure to progress in overweight and obese women were BMI (adjusted odds ratio [aOR (95% CI)] 1.15 (1.07-1.22) per 5 unit increase, maternal age 1.37 (1.17-1.61) per 5 year increase, height 1.09 (1.06-1.12) per 1cm reduction), induction of labour 1.94 (1.38-2.73) and prolonged pregnancy ≥41 weeks 1.64 (1.14-2.35).
  
  
  CONCLUSIONS
  Elevated maternal cholesterol in early pregnancy is not a risk factor for first stage caesarean for failure to progress in overweight/obese women. Other clinically relevant risk factors identified are: increasing maternal BMI, increasing maternal age, induction of labour and prolonged pregnancy ≥41 weeks' of gestation.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Auckland, Private Bag 92019, Auckland, New Zealand. e.fyfe@auckland.ac.nz
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Fyfe
authors.forename: Karen S
authors.initials: KS
authors.lastname: Rivers
authors.forename: John M D
authors.initials: JM
authors.lastname: Thompson
authors.forename: Kamala P L
authors.initials: KP
authors.lastname: Thiyagarajan
authors.forename: Katie M
authors.initials: KM
authors.lastname: Groom
authors.forename: Gustaaf A
authors.initials: GA
authors.lastname: Dekker
authors.forename: Lesley M E
authors.initials: LM
authors.lastname: McCowan
mesh_terms: D015992:Body Mass Index; D002585:Cesarean Section; D002784:Cholesterol / Q000097:blood*; D016001:Confidence Intervals; D004420:Dystocia / Q000097:blood / Q000209:etiology / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood* / Q000150:complications; D007747:Labor Stage, First; D007751:Labor, Induced; D008423:Maternal Age; D015999:Multivariate Analysis; D009765:Obesity / Q000097:blood* / Q000150:complications; D016017:Odds Ratio; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000097:blood; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D002784:Cholesterol