title: Pregestational excess weight, maternal obstetric complications and mode of delivery in the Rhea cohort in Crete.
abstract: BACKGROUND
  There has been a significant increase in overweight and obesity worldwide reaching global epidemic, with dramatic increase also among women of reproductive age or entering pregnancy. Aims of the study were to estimate the prevalence of maternal pregestational overweight and obesity and their association with and contribution to maternal obstetric complications and mode of delivery.
  
  
  METHODS
  One thousand two hundred eighty-six women with singleton pregnancies were followed-up prospectively from early pregnancy to delivery in Crete.
  
  
  RESULTS
  The prevalence of pre-pregnancy overweight and obesity were 20 and 11.5%, respectively. After adjusting for potential confounders, overweight and/or obesity were associated with an increased risk for caesarean deliveries [RR(overweight_vs._normal) BMI = 1.21, 95% CI (1.06, 1.38), RR(obese_vs._normal) BMI = 1.21, 95% CI (1.02, 1.42)], gestational diabetes mellitus [RR(obese_vs._normal) BMI = 2.11, 95% CI (1.28, 3.47)] and high blood pressure [RR(severy.obese_vs._normal) BMI = 3.32, 95% CI (1.36, 8.06)] any time in pregnancy. Pre-pregnancy excess weight has potentially contributed to 21% of planned caesarean deliveries in primiparae (almost 45% of such cases among overweight/obese primiparea were potentially attributed to pregestational excess weight). One-third of gestational hypertension and gestational diabetes cases among overweight/obese mothers could be attributed to pregestational excess weight, although results did not reach statistical significance.
  
  
  CONCLUSIONS
  Pregestational overweight and obesity continued to increase even more in recent years. Findings further support that maternal excess weight has a significant effect on and contribution to multiple maternal obstetric complications and the mode of delivery, underlining the necessity of obesity prevention, health policy strategies and health care that can result in significant individual and societal benefits.
authors: 1 Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece 2 Department of Neurology and Division of Epidemiology, Mayo Clinic, Rochester, MN, USA mvassilaki@med.uoc.gr.
authors: Maria
authors: M
authors: Vassilaki
authors: 1 Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
authors: Leda
authors: L
authors: Chatzi
authors: 1 Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
authors: Vaggelis
authors: V
authors: Georgiou
authors: 1 Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
authors: Anastas
authors: A
authors: Philalithis
authors: 3 Department of Nursing, Technological Educational Institute (TEI) of Crete, Crete, Greece.
authors: Giorgos
authors: G
authors: Kritsotakis
authors: 1 Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
authors: Antonis
authors: A
authors: Koutis
authors: 4 Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain 5 IMIM (Hospital del Mar Research Institute), Barcelona, Spain 6 CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain 7 National School of Public Health, Athens, Greece.
authors: Manolis
authors: M
authors: Kogevinas
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011446:Prospective Studies