title: Obesity and Neonatal Cord Blood Gas Results at Cesarean: Effect of Intraoperative Blood Pressure.
abstract: ObjectiveOur aims were to evaluate whether there is an inverse association between body mass index (BMI) and umbilical artery pH and to investigate the contribution of intraoperative hypotension on the umbilical artery pH.Study DesignWe conducted a retrospective cohort study of all women with a nonanomalous singleton at 37 to 41 weeks who underwent a scheduled cesarean delivery under spinal anesthesia at our facility from January 2006 to March 2012. The primary outcome was the proportion of patients in each BMI category with arterial cord pH < 7.10. Intraoperative blood pressure data were compared across BMI categories.ResultsIn total, 717 mother-infant pairs met enrollment criteria. Mean arterial pH was significantly lower in women with elevated BMI (p= 0.014), notably with BMI ≥ 40 kg/m2. Baseline blood pressure increased linearly with increasing BMI (p< 0.001), however, so did the maximum drop in all blood pressure parameters (p< 0.001). After adjusting for potential confounders, including blood pressure, there was no longer an association between cord pH and BMI (p= 0.72).ConclusionFor women undergoing a scheduled cesarean delivery under spinal anesthesia, umbilical artery pH is lower in women with BMI ≥40 kg/m2. Relative hypotension after spinal anesthesia is more pronounced with increasing BMI and may explain this effect.
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Powell
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Charity J
authors.initials: CJ
authors.lastname: Morgan
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Cantu
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakawi
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Biggio
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Alan T N
authors.initials: ATN
authors.lastname: Tita
authors.affiliation: Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Jeff M
authors.initials: JM
authors.lastname: Szychowski
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Rodney K
authors.initials: RK
authors.lastname: Edwards
mesh_terms: D000328:Adult; D000407:Alabama; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D001784:Blood Gas Analysis; D001794:Blood Pressure; D015992:Body Mass Index; D002585:Cesarean Section / Q000009:adverse effects; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D016343:Monitoring, Intraoperative; D015999:Multivariate Analysis; D009765:Obesity / Q000503:physiopathology*; D011247:Pregnancy; D012044:Regression Analysis; D012189:Retrospective Studies; D014469:Umbilical Arteries / Q000502:physiology; D055815:Young Adult