Maternal super-obesity.
OBJECTIVE
Pregnant women with a body-mass-index (BMI) above 50 are referred to as "super-obese". For these women adverse pregnancy outcome and a higher risk of fetal congenital defects are major issues. This report focuses on the ratio development of super-obesity in pregnant women, as well as on prenatal ultrasound and pregnancy outcome in the super-obese gravida.


METHODS
We reviewed data of all women with a BMI above 30 who delivered at our unit in a 15-year period between January 2000 and December 2014. Data of obese but not super-obese mothers were evaluated in comparison.


RESULTS
Final evaluation comprised 69/20,711 pregnancies of super-obese mothers. Forty out of 69 women suffered from a preexisting condition requiring medical treatment. Fetal ultrasound evaluation revealed severe congenital defects in four cases. There were no missed and no false positive diagnoses. Elective cesarean section (c-section) took place in 26/69 cases, 21/69 had a secondary c-section. Twenty-two out of 69 women delivered vaginally. Mean gestational age at delivery was 38(+6) gestational weeks. Pregnancy was complicated by macrosomia in 17/69 pregnancies. Severe neonatal hypoglycemia occurred in 6/69 cases. The number of deliveries by super-obese mothers showed no marked variation during the study period. In contrast the rate of deliveries by obese, but not super-obese, mothers showed an increase.


CONCLUSIONS
Maternal super-obesity poses a high-risk situation for mother and child which generally demands a higher amount of perinatal care. The number of deliveries by super-obese mothers remained stable over the study period. Primary c-section was the most frequent mode of delivery. Of the parturients who opted for vaginal delivery nearly half of the deliveries had to be completed by secondary c-section. Over-all peripartal maternal complications did not exceed average.
Department of Prenatal Medicine, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany. dhartge@gmail.com.
David
D
Hartge
Department of Prenatal Medicine, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.
Juliane
J
Spiegler
Department of Prenatal Medicine, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.
Andreas
A
Schroeer
Department of Prenatal Medicine, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.
Verena
V
Deckwart
Department of Prenatal Medicine, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538, Luebeck, Germany.
Jan
J
Weichert
D000328:Adult; D001724:Birth Weight; D015992:Body Mass Index; D002585:Cesarean Section / Q000706:statistics & numerical data; D015897:Comorbidity; D036861:Delivery, Obstetric / Q000379:methods; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007231:Infant, Newborn; D009767:Obesity, Morbid / Q000175:diagnosis / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics / Q000453:epidemiology; D016216:Ultrasonography, Prenatal / Q000379:methods*
Fetal macrosomia; High-risk pregnancy; Maternal hyperalimentation; Mode of delivery; Prenatal ultrasound