title: Relationship between maternal obesity and prenatal, metabolic syndrome, obstetrical and perinatal complications of pregnancy in Indiana, 2008-2010.
abstract: BACKGROUND
  Obesity is a serious medical condition affecting more than 30% of Indiana, and 25% of Unites States pregnant women. Obesity is related to maternal complications, and significantly impacts the health of pregnant women. The objective of this study was to describe the relationship between maternal complications and pre-pregnancy maternal weight.
  
  
  METHODS
  Using logistic regression models, we analyzed 2008 to 2010 birth certificate data, for 255,773 live births abstracted from the Indiana Vital Statistics registry. We examined the risk of reproductive factors, obstetrical complications and perinatal (intrapartum) complications for underweight, healthy weight, overweight and obese women for this population.
  
  
  RESULTS
  Women who received prenatal care were more likely to be obese [adjusted odds ratio (AOR) = 1.82 (1.56-2.13)]. While women with parity of zero (0) were less likely to be obese [AOR = 0.89, 95% CI (0.86-0.91)]. Women giving birth to twins [AOR = 1.25, 95% CI (1.17- 1.33)], women delivering by Caesarian section [AOR = 2.31, 95% CI ( 2.26-2.37)], and women who previously had a Caesarian section [AOR = 1.95, 95% CI (1.88-2.02)] were more likely to be obese. There was evidence of metabolic like complication in this population, due to obesity. Obesity was significantly associated with obstetrical conditions of the metabolic syndrome, including pre-pregnancy diabetes, gestational diabetes, pre-pregnancy hypertension, pregnancy-induced hypertension and eclampsia [AOR = 5.12, 95% CI (4.47-5.85); AOR = 3.87, 95% CI (3.68-4.08); AOR = 7.66, 95% CI (6.77-8.65); AOR = 3.23, 95% CI (3.07-3.39); and AOR = 1.77, 95% CI (1.31-2.40), respectively. Maternal obesity modestly increased the risk of induction, epidural, post-delivery bleeding, and prolonged labor [AOR = 1.26, 95% CI (1.23-1.29); AOR = 1.15, 95% CI (1.13-1.18); AOR = 1.20, 95% CI (1.12-1.28); and AOR = 1.44, 95% CI (1.30-1.61)], respectively. Obese women were less likely to have blood transfusions [AOR = .74, 95% CI (0.58-96)], vaginal tears [AOR = 0.51, 95% CI (0.44-0.59)], or infections [AOR = 86, 95% CI (0.80-0.93)].
  
  
  CONCLUSIONS
  Our results suggest that maternal obesity in Indiana, like other populations in the USA, is associated with high risks of maternal complications for pregnant women. Pre-pregnancy obesity prevention efforts should focus on targeting children, adolescent and young women, if the goal to reduce the risk of maternal complications related to obesity, is to be reached.
authors.affiliation: Epidemiology and Biostatistics Track, School of Health Systems and Public Health, University of Pretoria, 5-10 H.W. Snyman Building, 31 Bophelo Road, Gezina, 0031, Pretoria, South Africa. shinga.feresu@up.ac.za.|School of Health Sciences, College of Health Sciences, Walden University, 155 Fifth Ave. South, Suite 100, Minneapolis, MN, 55401, USA. shinga.feresu@up.ac.za.
authors.forename: Shingairai A
authors.initials: SA
authors.lastname: Feresu
authors.affiliation: Department of Statistics, Indiana University, Indiana Statistical Consulting Center, 309 N Park Ave, Bloomington, IN, 47405, USA. zephyrwang113@gmail.com.
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Statistics, Indiana University, Indiana Statistical Consulting Center, 309 N Park Ave, Bloomington, IN, 47405, USA. sd3@indiana.edu.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dickinson
mesh_terms: D000293:Adolescent; D000328:Adult; D001835:Body Weight; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D024821:Metabolic Syndrome / Q000150:complications* / Q000453:epidemiology; D009765:Obesity / Q000150:complications*; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology*; D011256:Pregnancy Outcome; D055815:Young Adult