Impact of Maternal Obesity on Perinatal Outcomes in Preterm Prelabor Rupture of Membranes ≥34 Weeks

Tara A. Lynch; Amol Malshe; Sarah Colihan; Jeffrey Meyers; Dongmei Li; Conisha Holloman; Eleazar Soto-Torres; Courtney Olson-Chen

doi:10.1055/s-0039-1698833

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2020; 37(05): 467-474
DOI: 10.1055/s-0039-1698833

SMFM Fellowship Series Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Maternal Obesity on Perinatal Outcomes in Preterm Prelabor Rupture of Membranes ≥34 Weeks

Authors

Tara A. Lynch

¹Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, New York
Amol Malshe

¹Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, New York
Sarah Colihan

²Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
Jeffrey Meyers

³Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
Dongmei Li

⁴Department of Clinical and Translational Research, Department of Obstetrics and Gynecology, Department of Public Health Sciences, University of Rochester, Rochester, New York
Conisha Holloman

⁵Department of Obstetrics and Gynecology, Winnie Palmer Hospital for Women and Babies, Orlando Health, Orlando, Florida
Eleazar Soto-Torres

⁶Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Texas–Houston, Houston, Texas
Courtney Olson-Chen

¹Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester Medical Center, Rochester, New York

Abstract

Objective This study aimed to compare pregnancy outcomes in obese and nonobese women with preterm prelabor rupture of membranes (PPROM) ≥34 weeks.

Study Design The present study is a secondary analysis of a multicenter retrospective cohort of singletons with PPROM from 2011 to 2017. Women with a delivery body mass index (BMI) ≥30 kg/m² (obese) were compared with women with a BMI < 30 kg/m² (nonobese). Pregnancies were stratified based on delivery policies of expectant management until 35 weeks versus immediate delivery ≥34 weeks. The primary outcome was a composite neonatal outcome (neonatal sepsis, antibiotic administration for duration >72 hours after delivery or respiratory support). Univariate analysis and general estimating equations models including maternal age, delivery timing, mode of delivery, hospital, and gestational age were used with p < 0.05 level of significance.

Results Among 259 pregnancies, 47% were obese. Pregnant women with obesity had increased composite neonatal outcome versus nonobese pregnancies (adjusted odds ratio [aOR] = 1.48 [95% confidence interval (CI): 1.01–2.17]). Obesity was also associated with increased neonatal antibiotic administration for a duration >72 hours after delivery, respiratory support, ventilation, oxygen supplementation, and surfactant administration. When stratified by delivery policies there was no significant difference in perinatal outcomes based on obesity.

Conclusion Obese women with PPROM ≥34 weeks have an increased odds of adverse neonatal respiratory and infectious outcomes compared with nonobese women.

Keywords

obesity - preterm prelabor rupture of membranes - late preterm delivery

Volltext

Referenzen

References
1 Waters TP, Mercer B. Preterm PROM: prediction, prevention, principles. Clin Obstet Gynecol 2011; 54 (02) 307-312
2 Horton AL, Lai Y, Rouse DJ. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Effect of magnesium sulfate administration for neuroprotection on latency in women with preterm premature rupture of membranes. Am J Perinatol 2015; 32 (04) 387-392
3 McIntire DD, Leveno KJ. Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol 2008; 111 (01) 35-41
4 Bond DM, Middleton P, Levett KM. , et al. Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome. Cochrane Database Syst Rev 2017; 3: CD004735
5 van der Ham DP, van der Heyden JL, Opmeer BC. , et al. Management of late-preterm premature rupture of membranes: the PPROMEXIL-2 trial. Am J Obstet Gynecol 2012; 207 (04) 276.e1-276.e10
6 Morris JM, Roberts CL, Bowen JR. , et al; PPROMT Collaboration. Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial. Lancet 2016; 387 (10017): 444-452
7 Finkelstein EA, Khavjou OA, Thompson H. , et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med 2012; 42 (06) 563-570
8 Crane JM, Murphy P, Burrage L, Hutchens D. Maternal and perinatal outcomes of extreme obesity in pregnancy. J Obstet Gynaecol Can 2013; 35 (07) 606-611
9 Nohr EA, Vaeth M, Bech BH, Henriksen TB, Cnattingius S, Olsen J. Maternal obesity and neonatal mortality according to subtypes of preterm birth. Obstet Gynecol 2007; 110 (05) 1083-1090
10 Faucett AM, Metz TD, DeWitt PE, Gibbs RS. Effect of obesity on neonatal outcomes in pregnancies with preterm premature rupture of membranes. Am J Obstet Gynecol 2016; 214 (02) 287.e1-287.e5
11 Smid MC, Vladutiu CJ, Dotters-Katz SK, Manuck TA, Boggess KA, Stamilio DM. Maternal Super Obesity and Neonatal Morbidity after Term Cesarean Delivery. Am J Perinatol 2016; 33 (12) 1198-1204
12 Lynch TA, Olson-Chen C, Colihan S. , et al. Preterm prelabor rupture of membranes: outcomes with expectant management until 34 versus 35 weeks. Am J Perinatol 2019; 36 (07) 659-668
13 Gyamfi-Bannerman C, Thom EA, Blackwell SC. , et al; NICHD Maternal–Fetal Medicine Units Network. Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med 2016; 374 (14) 1311-1320
14 Ronzoni S, Steckle V, D'Souza R. , et al. Cytokine changes in maternal peripheral blood correlate with time-to-delivery in pregnancies complicated by premature prelabor rupture of the membranes. Reprod Sci 2019; 26 (09) 1266-1276
15 Singer M, Deutschman CS, Seymour CW. , et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016; 315 (08) 801-810
16 Lock MC, McGillick EV, Orgeig S. , et al. Differential effects of late gestation maternal overnutrition on the regulation of surfactant maturation in fetal and postnatal life. J Physiol 2017; 595 (21) 6635-6652
17 Kim T, Burn SC, Bangdiwala A, Pace S, Rauk P. Neonatal morbidity and maternal complication rates in women with a delivery body mass index of 60 or higher. Obstet Gynecol 2017; 130 (05) 988-993
18 Kalagiri RR, Carder T, Choudhury S. , et al. Inflammation in complicated pregnancy and its outcome. Am J Perinatol 2016; 33 (14) 1337-1356
19 Menon R, Fortunato SJ. Infection and the role of inflammation in preterm premature rupture of the membranes. Best Pract Res Clin Obstet Gynaecol 2007; 21 (03) 467-478
20 Hadley EE, Discacciati A, Costantine MM. , et al. Maternal obesity is associated with chorioamnionitis and earlier indicated preterm delivery among expectantly managed women with preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2019; 32 (02) 271-278
21 Romero R, Chaemsaithong P, Korzeniewski SJ. , et al. Clinical chorioamnionitis at term III: how well do clinical criteria perform in the identification of proven intra-amniotic infection?. J Perinat Med 2016; 44 (01) 23-32
22 Mortier I, Blanc J, Tosello B, Gire C, Bretelle F, Carcopino X. Is gestational diabetes an independent risk factor of neonatal severe respiratory distress syndrome after 34 weeks of gestation? A prospective study. Arch Gynecol Obstet 2017; 296 (06) 1071-1077
23 Gyamfi-Bannerman C. Antenatal corticosteroids: it's all about timing. BJOG 2017; 124 (10) 1575