title: The risk of prelabor and intrapartum cesarean delivery among overweight and obese women: possible preventive actions.
abstract: OBJECTIVE
  The purpose of this study was to investigate prelabor and intrapartum cesarean delivery in overweight and obese women by parity, previous cesarean delivery, and labor induction to assess what preventive actions might be possible.
  
  
  METHODS
  We modeled relative risks (RRs) and risk differences of prelabor and intrapartum cesarean delivery by prepregnancy body mass index (obese, ≥30 kg/m(2); overweight, 25-29.9 kg/m(2); normal weight, 18.5-24.9 kg/m(2)) in a nationally representative sample of 12,297 French women. Models were stratified by parity and previous cesarean status. Covariates included maternal sociodemographic characteristics, medical conditions, pregnancy complications, and induction of labor.
  
  
  RESULTS
  Risks of prelabor cesarean delivery were elevated only for obese multiparous women. This reflected not only a higher prevalence of previous cesarean delivery (26.4% vs 17.9% for normal-weight women) but also higher risks of prelabor cesarean delivery for multiparous women with no previous cesarean delivery after adjustment for medico-obstetric factors (RR, 1.82; 95% confidence interval [CI], 1.25-2.64). Obese primiparous women and multiparous women with no previous cesarean delivery had similarly increased adjusted RRs for intrapartum cesarean delivery (RR, 1.64; 95% CI, 1.36-1.98; and RR, 1.66; 95% CI, 1.15-2.39, respectively), but the risk difference was higher for primiparous women, with an absolute increase of 0.10 (95% CI, 0.05-0.14) compared with 0.02 (95% CI, 0.00-0.04) for multiparous women. Increased intrapartum cesarean delivery risks for primiparous women were related to more frequent labor induction (42.6% vs 23.8% for normal-weight women).
  
  
  CONCLUSIONS
  It may be possible to reduce primary and thus repeat cesarean delivery rates among obese women by preventive actions targeting labor induction in primiparous women and prelabor cesarean deliveries in multiparous women. Further research is needed on the impact of limiting inductions on cesarean delivery risks for obese primiparous women.
authors.affiliation: INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris V, René Descartes University, Paris, France; Department of Obstetrics and Gynecology, Port-Royal Maternity, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France. Electronic address: monika.hermann84@gmail.com.
authors.forename: Monika
authors.initials: M
authors.lastname: Hermann
authors.affiliation: INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris V, René Descartes University, Paris, France; Department of Obstetrics and Gynecology, Port-Royal Maternity, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Le Ray
authors.affiliation: INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris V, René Descartes University, Paris, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Blondel
authors.affiliation: INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris V, René Descartes University, Paris, France; Department of Obstetrics and Gynecology, Port-Royal Maternity, Groupe Hospitalier Cochin-Broca-Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Goffinet
authors.affiliation: INSERM UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris V, René Descartes University, Paris, France.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Zeitlin
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data*; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007751:Labor, Induced / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology; D010298:Parity; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000706:statistics & numerical data
keywords: cesarean; obesity; uterine scar