title: Maternal body mass index and duration of labor.
abstract: OBJECTIVE
  To evaluate whether the duration of the active phase of labor is associated with maternal body mass index (BMI), in nulliparous women with spontaneous onset of labor.
  
  
  METHODS
  Historical prospective cohort study including 63,829 nulliparous women with a singleton pregnancy and a spontaneous onset of labor, who delivered between January 1, 1995 and December 31, 2009. Data were collected from the Perinatal Revision South registry, a regional perinatal database in Southern Sweden. Women were categorized into six classes of BMI. Overweight and obese women were compared to normal weight women regarding duration of active labor. Adjustments were made for year of delivery, maternal age and infant birth weight.
  
  
  RESULTS
  The median duration of labor was significantly longer in obese women (class I obesity (BMI 30-34.9) = 9.1h, class II obesity (BMI 35-39.9) = 9.2h and class III obesity (BMI > 40) = 9.8h) compared to normal-weight women (BMI 18.5-24.9) = 8.8h (p < 0.001). The risk of labor lasting more than 12h increased with increasing maternal BMI: OR 1.04 (1.01-1.06) (OR per 5-units BMI-increase).The risk of labor lasting more than 12h or emergency cesarean section within 12h, compared to vaginal deliveries within 12h, increased with increasing maternal BMI. Duration of the second stage of labor was significantly shorter in obese women: in class III obesity the median value was 0.45 h compared to normal weight women, 0.55 h (p < 0.001).
  
  
  CONCLUSIONS
  In nulliparous women with a spontaneous onset of labor, duration of the active phase of labor increased significantly with increasing maternal BMI. Once obese women reach the second stage they deliver more quickly than normal weight women, which implies that the risk of prolonged labor is restricted to the first stage of labor. It is clinically important to consider the prolonged first stage of labor in obese women, for example when diagnosing first stage labor arrest, in order to optimize management of this rapidly growing at-risk group of women. Thus, it might be reasonable to adapt the considered upper limit for duration of labor, according to maternal BMI.
authors.affiliation: Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Obstetrics and Gynecology in Linköping, County Council of Östergötland, Linköping, Sweden. Electronic address: sara.carlhall@lio.se.
authors.forename: Sara
authors.initials: S
authors.lastname: Carlhäll
authors.forename: Karin
authors.initials: K
authors.lastname: Källén
authors.forename: Marie
authors.initials: M
authors.lastname: Blomberg
mesh_terms: D000328:Adult; D001724:Birth Weight; D015992:Body Mass Index; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007747:Labor Stage, First; D007743:Labor, Obstetric / Q000502:physiology*; D009765:Obesity / Q000150:complications; D009767:Obesity, Morbid / Q000150:complications; D050177:Overweight / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications; D011446:Prospective Studies; D013548:Sweden; D013997:Time Factors
keywords: Active phase of labor; Maternal body mass index; Nulliparous women; Obesity; Second stage of labor