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Oxytocin Dosing Intensity and Labor Induction Outcomes by Maternal Body Mass Index
Rebecca M Cohen1, Chelsea A DeBolt1, Zhan Zhao1
1Icahn School of Medicine at Mount Sinai, New York, New York; Department of Obstetrics, Gynecology and Reproductive Science and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; and Department of Obstetrics and Gynecology and Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadephia, Pennsylvania.
Higher oxytocin doses increase risks for cesarean delivery and postpartum hemorrhage (PPH), especially in normal-weight individuals. However, these risks are reduced in individuals with obesity, suggesting tailored dosing strategies are needed.
Area of Science:
- Obstetrics and Gynecology
- Reproductive Medicine
- Maternal-Fetal Medicine
Background:
- Oxytocin is commonly used for labor induction.
- Associations between oxytocin dosing intensity and maternal outcomes like cesarean delivery and postpartum hemorrhage (PPH) require further investigation, particularly across different body mass index (BMI) categories.
Purpose of the Study:
- To examine the associations between oxytocin dosing intensity and maternal outcomes (cesarean delivery and PPH) stratified by body mass index (BMI).
Main Methods:
- Retrospective cohort study of singleton births from 2013-2022.
- Classified BMI into normal weight, overweight, class I-II obesity, and class III obesity.
- Categorized maximum oxytocin dose rate into quartiles and used modified Poisson regression to estimate risk ratios, adjusting for multiple covariates.
Main Results:
- Higher oxytocin doses (highest quartile) were associated with increased risk of cesarean delivery and PPH.
- These risks were more pronounced in normal-weight individuals compared to those with obesity.
- Individuals with overweight or obesity receiving third-quartile oxytocin dosing showed no increased PPH risk.
Conclusions:
- Elevated BMI correlates with increased oxytocin requirements.
- The risks associated with higher oxytocin dosing appear attenuated in individuals with higher BMI.
- Tailored oxytocin dosing strategies may enhance labor efficacy and maternal safety.
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