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Association between Elevated Pre-pregnancy BMI and Outcomes of Labour Induction: A Population-Based Retrospective
Kaija Käärid1, Erin Marshall1, Richard Honor2
1Department of Obstetrics and Gynecology, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL.
Objectives:
This study aimed to evaluate the effects of elevated pre-pregnancy BMI on the outcomes of labour induction, especially for those in higher BMI categories.
Methods:
This was a population-based retrospective cohort study using data from the Perinatal Program Newfoundland and Labrador database from 2002 to 2023. Mode of delivery was the primary outcome of interest. Composite secondary maternal and neonatal outcomes and a severity-weighted composite outcome were calculated. Outcomes were analyzed using logistic and Poisson regressions, adjusting for patient age, gestational age, parity, and smoking status. Adjusted risks or rates with associated 95% CIs were reported for each outcome. Outcome data were used to produce a clinical risk calculator.
Results:
Analyses included 16 808 records. The risks of unplanned and emergency cesarean delivery (CD) increased with BMI in a dose-dependent manner. For example, the adjusted risks of unplanned and emergency CD at a BMI of 20.0 kg/m2 were 22.5% (95% CI 20.8-24.3) and 17.0% (95% CI 15.5-18.6), respectively. In comparison, these risks increased to 59.8% (95% CI 44.8-73.3) and 49.5% (95% CI 34.7-64.3), respectively, at a BMI of 65.0 kg/m2. The opposite trend was observed for spontaneous vaginal delivery. The severity-weighted composite outcome was lowest at a BMI of 19.0 kg/m2 (17.5; 95% CI 17.0-17.9) and increased to a maximum at a BMI of 48.0 kg/m2 (33.9; 95% CI 33.3-34.5).
Conclusions:
Elevated BMI increases risks of unplanned and emergency CD among those who undergo induction of labour. Our risk calculator can provide additional information for patient assessment and counselling.
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