title: Maternal Super Obesity and Neonatal Morbidity after Term Cesarean Delivery.
abstract: Objective To estimate the association between maternal super obesity (body mass index [BMI] ≥ 50 kg/m(2)) and neonatal morbidity among neonates born via cesarean delivery (CD). Methods Retrospective cohort of singleton neonates delivered via CD ≥ 37 weeks in the Maternal-Fetal Medicine Unit Cesarean Registry. Maternal BMI at delivery was stratified as 18.5 to 29.9 kg/m(2), 30 to 39.9 kg/m(2), 40 to 49.9 kg/m(2), and ≥ 50 kg/m(2). Primary outcomes included acute (5-minute Apgar score < 5, cardiopulmonary resuscitation and ventilator support < 24 hours, neonatal injury, and/or transient tachypnea of the newborn) and severe (grade 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, seizure, respiratory distress syndrome, hypoxic ischemic encephalopathy, meconium aspiration, ventilator support ≥ 2 days, sepsis and/or neonatal death) neonatal morbidity. Odds of neonatal morbidity were estimated for each BMI category adjusting for clinical and operative characteristics. Results Of 41,262 maternal-neonatal dyads, 36% of women were nonobese, 49% had BMI of 30 to 39.9 kg/m(2), 12% had BMI of 40 to 49.9 kg/m(2), and 3% were super obese. Compared with nonobese women, super obese women had twofold odds of acute (5 vs. 10%; adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.59-2.73) and severe (3 vs. 6%; aOR: 2.08; 95% CI: 1.59-2.73) neonatal morbidity. Conclusion Among term infants delivered via CD, maternal super obesity is associated with increased risk of neonatal morbidity.
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Marcela C
authors.initials: MC
authors.lastname: Smid
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Vladutiu
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Dotters-Katz
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Manuck
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Boggess
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: David M
authors.initials: DM
authors.lastname: Stamilio
mesh_terms: D000328:Adult; D001034:Apgar Score; D015992:Body Mass Index; D016887:Cardiopulmonary Resuscitation; D000074042:Cerebral Intraventricular Hemorrhage / Q000453:epidemiology; D002585:Cesarean Section; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000453:epidemiology; D007231:Infant, Newborn; D008471:Meconium Aspiration Syndrome / Q000453:epidemiology; D009017:Morbidity; D009767:Obesity, Morbid / Q000453:epidemiology*; D066087:Perinatal Death; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology; D018805:Sepsis / Q000453:epidemiology; D059246:Tachypnea / Q000453:epidemiology; D047929:Term Birth; D014481:United States / Q000453:epidemiology; D055815:Young Adult