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Am J Perinatol
DOI: 10.1055/a-2515-2673
Original Article

The Dose-Dependent Effect of Obesity on Adverse Maternal and Neonatal Outcomes in a Hispanic Population

Sara I. Jones 
1   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Elise A. Rosenthal
1   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Jessica E. Pruszynski 
1   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
F. Gary Cunningham
1   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations Funding None.
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Abstract

Objective This study aimed to evaluate the frequency of adverse maternal and neonatal outcomes associated with maternal obesity in a Hispanic population. We hypothesized that obesity confers a dose-dependent risk associated with these outcomes.

Study Design This was a retrospective cohort study of singleton pregnancies delivered between 24 and 42 weeks gestation at an urban county hospital between 2013 and 2021. Body mass index (BMI) at the first prenatal visit was used as a proxy for prepregnancy weight. Patients were excluded if their first-trimester BMI was not available. Trends in adverse outcomes across increasing obesity classes were assessed.

Results During the study period, 58,497 patients delivered a singleton infant, of which 12,365 (21.1%), 5,429 (9.3%), and 3,482 (6.0%) were in class I, II, and III obesity, respectively. Compared with nonobese patients, obese patients were more likely to be younger and nulliparous with a higher incidence of hypertension and pregestational diabetes. Higher BMI was associated with a significant dose-dependent increase in cesarean delivery (27% for nonobese, 34% for class I, 39% for class II, and 46% for class III obesity); severe preeclampsia (8% in nonobese and 19% for class III obesity); and gestational diabetes (5% in nonobese and 15% in class III obesity). There were significant trends in increasing morbidity for infants born to patients with correspondingly higher obesity classes. Some of these adverse outcomes included respiratory distress syndrome, neonatal intensive care unit admission, fetal anomalies, and sepsis (all p < 0.001).

Conclusion Increasing body mass index is associated with a significant dose-dependent increase in multiple adverse perinatal outcomes in a Hispanic population. Associated adverse maternal outcomes include severe preeclampsia, gestational diabetes, and cesarean delivery. Infants born to patients with correspondingly higher BMI class have significantly increased associated morbidity. Often, only higher BMI classes are significantly associated with these adverse outcomes.

Key Points

  • As BMI increases, pregnant patients are more likely to experience adverse maternal and neonatal outcomes.

  • Many adverse pregnancy outcomes are associated only with a BMI greater than 40 kg/m2.

  • Obesity is associated with cesarean delivery, likely due to an increase in labor dystocia.

Keywords

obesity - maternal morbidity - neonatal outcomes - body mass index - hypoxic-ischemic encephalopathy - cesarean delivery

Note

This study was presented at “The 44th Annual Pregnancy Meeting,” Society for Maternal-Fetal Medicine, National Harbor, Maryland, February 10 to 14, 2024.




Publication History

Received: 11 May 2024

Accepted: 12 January 2025

Accepted Manuscript online:
14 January 2025

Article published online:
12 February 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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