Labour Progression in Obese Women: Are Women With Increased Body Mass Index Having Unnecessary Cesarean Sections?

OBJECTIVE: This study sought to determine whether obese pregnant women undergo cesarean sections without an adequate trial of labour. This may affect future birth and pregnancy outcomes. METHODS: A retrospective analysis was done on 526 parturients at Victoria Hospital in London, Ontario. Women were categorized according to parity and pre-pregnancy body mass index (BMI; normal weight, BMI 18.5-24.9 kg/m RESULTS: Obese class II and III primiparous women required an additional 1.62 and 2.67 hours (P = 0.012), respectively, to reach a dilation of 10 cm compared with their normal weight counterparts; obese class II and III multiparous women required an additional 1.25 and 2.05 hours (P = 0.003), respectively. A higher BMI was associated with increased oxytocin use and infant birth weight in primiparous women. Obese women had less gestational weight gain and required more cervical examinations. Cesarean section rates were low for obese parturients (primiparous, 19%; multiparous, 0.8%) and not significantly different among BMI categories. CONCLUSION: This study confirmed published results that labour progresses more slowly as maternal BMI increases. The study was performed in a centre with a specialized BMI pregnancy clinic; thus weight gain adherence, awareness of labour differences, and patient counselling may have contributed to low cesarean section rates. Obstetric care providers should consider differences in maternal BMI in labour progression before undertaking a potentially premature cesarean birth, especially in primiparous women

The association between alcohol outlet accessibility and adverse birth outcomes: A retrospective cohort study

BACKGROUND:Alcohol outlet accessibility is positively associated with alcohol consumption, although this relationship has not been thoroughly examined in pregnant women. The present study examines the relationship between proximity and density of alcohol outlets and risk for low birth weight (LBW: \u3c2,500 grams) and preterm birth (PTB: \u3c37 weeks gestational age), and is the first Canadian study to investigate this association. METHODS:Maternal accessibility to alcohol outlets was specified using a gravity-type measure of accessibility, which provides the amount of accessibility that a given household has to liquor stores within 30-minutes of their home. All singleton newborns without congenital anomalies that were born between February 2009 and February 2014 at London Health Sciences Centre in London, Ontario, were included in this cohort. RESULTS:The sample consisted of 25,734 live births, of which 5.8% were LBW and 7.6% were PTB. Only 2.0% of women reported alcohol use during pregnancy. Alcohol outlet gravity was positively correlated with the percentage of mothers living in poverty (rs = 0.33, p \u3c 0.001) and in single-parent families (rs = 0.39, p \u3c 0.001), and who self-identify as visible minorities (rs = 0.45, p \u3c 0.001). Alcohol outlet gravity increased the odds that mothers drank alcohol during pregnancy (OR 1.05; 95% CI: 1.02, 1.07), although the association was weak. Furthermore, alcohol outlet gravity did not increase the likelihood of a LBW or PTB infant. CONCLUSIONS:Women with high accessibility to alcohol outlets are more likely to consume alcohol during pregnancy, but greater alcohol outlet accessibility does not translate into poor birth outcomes

Socioeconomic status and adverse birth outcomes: a population-based Canadian sample

This study assessed the strength of the association between socioeconomic status (SES) and low birth weight (LBW) and preterm birth (PTB) in Southwestern Ontario. Utilizing perinatal and neonatal databases at the London Health Science Centre, maternal postal codes were entered into a Geographic Information System to determine home neighbourhoods. Neighbourhoods were defined by dissemination areas (DAs). Median household income for each DA was extracted from the latest Canadian Census and linked to each mother. All singleton infants born between February 2009 and February 2014 were included. Of 26,654 live singleton births, 6.4% were LBW and 9.7% were PTB. Top risk factors for LBW were: maternal amphetamine use, chronic hypertension and maternal marijuana use (OR respectively: 17.51, 3.18, 2.72); previously diagnosed diabetes, maternal narcotic use and insulin-controlled gestational diabetes predicted PTB (OR respectively: 17.95, 2.69, 2.42). Overall, SES had little impact on adverse birth outcomes, although low maternal education increased the likelihood of a LBW neonate (OR: 1.01)

Factors that influence excessive gestational weight gain: Moving beyond assessment and counselling

One in four Canadian adults is obese, and more women are entering pregnancy with a higher body mass index (BMI) than in the past. Pregnant women who are overweight or obese have a higher risk of pregnancy-related complications than women of normal weight. Gestational weight gain (GWG) is also associated with childhood obesity. Although the factors influencing weight gain during pregnancy are multifaceted, little is known about the social inequality of GWG. This review will address some of the socioeconomic factors and maternal characteristics influencing weight gain and the impact that excessive GWG has on health outcomes such as post-partum weight retention. The effects of an overweight or obese pre-pregnancy BMI on GWG and neonatal outcomes will also be addressed. The timing of weight gain is also important, as recommendations now include trimester-specific guidelines. While not conclusive, preliminary evidence suggests that excessive weight gain during the first trimester is most detrimental

Water-fat magnetic resonance imaging of adipose tissue compartments in the normal third trimester fetus

BACKGROUND: Assessment of fetal adipose tissue gives information about the future metabolic health of an individual, with evidence that the development of this tissue has regional heterogeneity. OBJECTIVE: To assess differences in the proton density fat fraction (PDFF) between fetal adipose tissue compartments in the third trimester using water-fat magnetic resonance imaging (MRI). MATERIALS AND METHODS: Water-fat MRI was performed in a 1.5-T scanner. Fetal adipose tissue was segmented into cheeks, thorax, abdomen, upper arms, forearms, thighs and lower legs. PDFF and R2* values were measured in each compartment. RESULTS: Twenty-eight women with singleton pregnancies were imaged between 28 and 38 weeks of gestation. At 30 weeks\u27 gestation (n=22), the PDFF was statistically different between the compartments (P CONCLUSION: Fetal adipose tissue accumulates lipids at a similar rate in all white adipose tissue compartments. PDFF variances between the compartments suggest that accumulation begins at different gestational ages, starting with cheeks, followed by extremities, trunk and abdomen. Additionally, MRI was able to detect differences in the PDFF between fetal brown adipose tissue and white adipose tissue

Examining the pathways of pre- and postnatal health information

Objectives: The objectives of our study were to 1) assess Canadian women\u27s health information levels regarding pre- and postnatal topics in both primiparous and multiparous samples, and 2) identify factors associated with levels of health information in both groups and the pathways of such associations. Methods: Data from the 2006 Maternity Experiences Survey developed by the Canadian Perinatal Surveillance System (N=6,421) were used. The study population included mothers ≥15 years of age at the time of the birth, who had a singleton live birth in Canada during a three-month period preceding the 2006 Census and who lived with their infants at the time of the survey. Structural equation modeling was used to identify and examine pre- and postnatal acquired health information components in both samples and to assess factors that may influence this level of information. Results: Primiparous and multiparous women perceived insufficient levels of information on similar topics: pain medication/anesthesia, warning signs/complications, formula feeding and changes in sexual responses. This common finding underscored that these informational needs had a large impact on the entire population of pregnant women, rather than being parity-specific. Level of perceived social support was positively associated with information acquisition on all health topics studied in both samples (p\u3c0.0001 for both). Income was also positively associated with information levels to a similar extent on a range of topics in both samples (p\u3c0.0001 - p\u3c0.05). Conclusions: Canadian primiparous and multiparous women perceived an inadequate level of information on the same topics, identifying knowledge gaps that should be addressed. Perceived level of social support and income significantly influenced information levels on pre- and postnatal health topics. Therefore women with low income and those with perceived lack of social support may be identified by health care providers as requiring additional health information. © Canadian Public Health Association, 2012