Am J Perinatol
DOI: 10.1055/a-2096-7842
Original Article

Perinatal Morbidity in Healthy Obese Pregnant Individuals Delivered by Elective Repeat Cesarean at Term

1   Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
Duncan T. Harmon
2   Devision of Maternal-Fetal Medicine, St. Luke's Clinic, Maternal Fetal Medicine, Boise, Idaho
Melissa Gazi
3   Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
Jeff Szychowski
4   Department of Biostatistics, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
5   Division of Maternal-Fetal Medicine, University of Texas Dell Medical School, Austin, Texas
Alan T.N. Tita
1   Department of Obstetrics and Gynecology, Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
Akila Subramaniam
6   Division of Maternal-Fetal Medicine, University of Alabama at Birmingham Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations


Objective This study aimed to compare the risks of adverse perinatal outcomes by body mass index (BMI) categories in healthy pregnant individuals delivered by term elective repeat cesarean (ERCD) to describe an optimal timing of delivery in otherwise healthy patients at the highest-risk BMI threshold.

Study Design A secondary analysis of a prospective cohort of pregnant individuals undergoing ERCD at 19 centers in the Maternal–Fetal Medicine Units Network from 1999 to 2002. Nonanomalous singletons undergoing prelabor ERCD at term were included. The primary outcome was composite neonatal morbidity; secondary outcomes included composite maternal morbidity and individual components of the composites. Patients were stratified by BMI classes and to identify a BMI threshold for which morbidity was the highest. Outcomes were then examined by completed week's gestation, between BMI classes. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI).

Results A total of 12,755 patients were included in analysis. Patient's with BMI ≥ 40 had the highest rates of newborn sepsis, neonatal intensive care unit admissions, and wound complications. While a weight-related response was observed between BMI class and neonatal composite morbidity (p < 0.001), only those with BMI ≥ 40 had significantly higher odds of composite neonatal morbidity (aOR: 1.4, 95% CI: 1.0–1.8). In analyses of patients with BMI ≥ 40 (n = 1,848), there was no difference in the incidence of composite neonatal or maternal morbidity across weeks' gestation at delivery; however, as gestational age approached 39 to 40 weeks, rates of adverse neonatal outcomes decreased, only to increase again at 41 weeks' gestation. Of note, the odds of the primary neonatal composite were the highest at 38 weeks compared with 39 weeks (aOR: 1.5, 95% CI: 1.1–2.0).

Conclusion Neonatal morbidity is significantly higher in pregnant individuals with BMI ≥40 delivering by ERCD. Despite this increased perinatal morbidity, delivery prior to 39 and after 41 weeks in these patients is associated with increased neonatal risks.

Key Points

  • Obese patients without additional comorbidities have higher rates of neonatal morbidity.

  • Patients with BMI ≥ 40 carry the highest odds of poor perinatal outcomes.

  • Earlier timing of delivery does not appear to reduce this risk.


This was presented as two poster presentations at the 37th Annual Pregnancy Meeting, Society for Maternal Fetal Medicine, Las Vegas, Nevada, January 23 to 28, 2017; abstract 173 and 814.

Supplementary Material

Publication History

Received: 11 April 2023

Accepted: 03 May 2023

Accepted Manuscript online:
22 May 2023

Article published online:
12 June 2023

© 2023. Thieme. All rights reserved.

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