What to Expect When you’re Expecting an Infant from … you’re Expecting an Infant from a “Mother of Size ... Overall Obese Mothers Birthweight ≥ 4000g 10.4% 15.8% ... ratio

What to Expect When you’re Expecting

an Infant from a “Mother of Size”

BORN Provincial Rounds

May 16, 2013

Laura Gaudet,MSc, MD, FRCS

ObjectivesThrough participation in today’s

webinar, attendees will:

1. Be aware of the impact of a mother’s excess weight on her infant’s birthweight

2. Explore whether infants born to heavier mothers require additional resuscitative support

3. Discuss preventative measures to reduce newborn complications when the mother carries excess weight

Background

Obesity is common in Canada, In all age groups

Background

Distribution of Canadian adult females by BMI2009-2011 CHMS

CHMS 2009-2011: http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11708-eng.htm

BackgroundPercent distribution by BMI of children and

adolescents, age 6-17, 2009-2011

% in category 95% CIThin 2.3 1.2-4.5Normal weight 66.6 62.7-70.3Overweight 19.5 15.9-23.6Obese 11.6 9.8-13.7

CHMS 2009-2011: http://www.statcan.gc.ca/pub/82-003-x/2012003/article/11706/tbl/tbl3-eng.htm

Background

Obesity Definition:

“Obesity is a medical condition in which body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems”

http://en.wikipedia.org/wiki/Obesity

Background

Obesity causes “increased health problems” in pregnancy, including

• Hypertensive disorders• Diabetes• Macrosomia• Intrauterine fetal death• Delivery by Caesarean section• Admission to NICU

BackgroundMacrosomia = term that describes a

newborn who is significantly larger than average

Criteria:• ≥4000g• ≥4500g• ≥90th percentile

Background

Risk factorsHistory, diabetes, post-term pregnancy, maternal obesity, gender, non-smoking

ComplicationsMaternal, offspring

BackgroundCanadian Infants with Birthweight ≥ 4500g, 2011

≥4500g (n) % Birthweight ≥4500g Total births

Males 4168 2.2192884

Females 2014 1.1183332

Total 6182 1.6376216

Adapted from Stats Can: http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/health103a-eng.htm

Food for Thought

Given that:

“Obesity is a medical condition in which body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems”

Could fetal macrosomia be thought of as “fetal obesity”?

Background

Theme“improving the health of pregnant Canadian women who carry extra body weight and their offspring”

Background

We wondered:

A. How large the effect of excess maternal weight is in increasing birthweight

B. Whether immediate neonatal complications were more common when babies had mothers who were obese

Photo credit:USA Today

Mother’s Weight and Macrosomia

It has been shown previously that, in general, birthweights are higher for babies whose mothers are heavier

Systematic review of the literature was performed with the hypothesis that maternal obesity is associated with a significant increase in the prevalence of fetal macrosomia (birthweight ≥4000g, ≥4500g, ≥90th

percentile)

Mother’s Weight and Macrosomia

Included: observational studies that defined obesity as BMI ≥ 30 kg/m2, had a control group of women with BMI ≤ 25 kg/m2 and reported usable numbers

Excluded: articles without an English abstract

285 articles identified from electronic database search (PubMed, Medline, EMBASE)

__4__duplicate articles

__281__ articles and abstracts identified for initial screening

__14__articles identified by searching reference lists

_6__ articles excluded(2 articles not obtained by ILL, 4 non‐English articles without English abstract)

__289__ full articles retrieved after reviewing titles and abstracts

__259__ excluded studies (see Table 3.2 for details)

__30__Eligible studies included in the systematic review

Prevalence of Fetal Overgrowth

Overall Obese Mothers

Birthweight ≥ 4000g

10.4% 15.8%

Birthweight ≥ 4500g

2.1% 3.9%

Birthweight ≥ 90th percentile

22.4% 17.4%

Mother’s Weight and Birthweight ≥4000g

Study name Statistics for each study Odds ratio and 95% CIOdds Lower Upper ratio limit limit Z-Value p-Value

Bhattacharya2.168 1.886 2.493 10.875 0.000El-Gilany 7.060 1.532 32.545 2.507 0.012Stepan 2.861 2.276 3.597 9.004 0.000Van Wooten 4.722 0.901 24.751 1.837 0.066Mantakas 2.204 1.739 2.793 6.537 0.000Le Thai 23.885 3.088 184.716 3.040 0.002Brennand 3.756 2.340 6.027 5.483 0.000Crane 1.861 1.469 2.359 5.143 0.000Sukalich 1.785 1.295 2.460 3.538 0.000Jensen 1.432 1.148 1.786 3.181 0.001Baeten 1.951 1.841 2.067 22.570 0.000Driul 2.576 1.073 6.187 2.117 0.034Roman 3.106 2.284 4.223 7.225 0.000Sahu 25.576 1.019 642.214 1.971 0.049Rode 1.881 1.525 2.319 5.909 0.000Langer 1.893 1.431 2.503 4.474 0.000

2.169 1.917 2.453 12.311 0.0000.01 0.1 1 10 100Favours Maternal Non-obesity

Favours Maternal Obesity

Figure 3.3 Forest Plot for Macrosomia (>/= 4000g)Study name Statistics for each study Odds ratio and 95% CI

Odds Lower Upper ratio limit limit Z-Value p-Value

Bhattacharya2.168 1.886 2.493 10.875 0.000El-Gilany 7.060 1.532 32.545 2.507 0.012Stepan 2.861 2.276 3.597 9.004 0.000Van Wooten 4.722 0.901 24.751 1.837 0.066Mantakas 2.204 1.739 2.793 6.537 0.000Le Thai 23.885 3.088 184.716 3.040 0.002Brennand 3.756 2.340 6.027 5.483 0.000Crane 1.861 1.469 2.359 5.143 0.000Sukalich 1.785 1.295 2.460 3.538 0.000Jensen 1.432 1.148 1.786 3.181 0.001Baeten 1.951 1.841 2.067 22.570 0.000Driul 2.576 1.073 6.187 2.117 0.034Roman 3.106 2.284 4.223 7.225 0.000Sahu 25.576 1.019 642.214 1.971 0.049Rode 1.881 1.525 2.319 5.909 0.000Langer 1.893 1.431 2.503 4.474 0.000

2.169 1.917 2.453 12.311 0.0000.01 0.1 1 10 100Favours Maternal Non-obesity


Figure 3.3 Forest Plot for Macrosomia (>/= 4000g)

OR 2.17 [95% CI 1.92, 2.45}

Mother’s Weight and Birthweight ≥4500g

OR 2.17 [95% CI 1.92, 2.45}

Study name Statistics for each study Odds ratio and 95% CI


Clausen 2005 3.717 1.864 7.411 3.729 0.000Brennand 2005 2.936 1.400 6.158 2.849 0.004Lumme 1995 2.231 1.445 3.445 3.622 0.000Jensen 1999 2.024 1.212 3.381 2.694 0.007Khashan 2009 3.234 2.860 3.657 18.730 0.000Mantakas 2010 3.723 2.080 6.663 4.426 0.000Crane 2009 1.870 1.283 2.725 3.257 0.001Athukorala 20104.683 2.030 10.802 3.620 0.000

2.766 2.218 3.450 9.027 0.000

0.01 0.1 1 10 100FavoursMaternal Non-obesity

FavoursMaternal Obesity




Clausen 2005 3.717 1.864 7.411 3.729 0.000Brennand 2005 2.936 1.400 6.158 2.849 0.004Lumme 1995 2.231 1.445 3.445 3.622 0.000Jensen 1999 2.024 1.212 3.381 2.694 0.007Khashan 2009 3.234 2.860 3.657 18.730 0.000Mantakas 2010 3.723 2.080 6.663 4.426 0.000Crane 2009 1.870 1.283 2.725 3.257 0.001Athukorala 20104.683 2.030 10.802 3.620 0.000

2.766 2.218 3.450 9.027 0.000

0.01 0.1 1 10 100FavoursMaternal Non-obesity

FavoursMaternal Obesity


Mother’s Weight and Birthweight ≥90th percentile



Hoff 0.860 0.367 2.018 -0.346 0.729Leung 3.188 2.632 3.861 11.863 0.000Nohr 2.743 2.519 2.986 23.231 0.000Getahun 2.061 1.973 2.152 32.709 0.000Narchi 2.468 2.107 2.890 11.205 0.000Magann 2.721 2.066 3.583 7.127 0.000Lumme 2.777 2.117 3.644 7.374 0.000Bodnar 4.328 3.886 4.821 26.635 0.000Voigt 2.452 2.387 2.519 65.143 0.000Salihu 1.964 1.929 2.000 72.996 0.000Jensen 1.606 1.266 2.038 3.903 0.000Athukorala 2.261 1.521 3.362 4.033 0.000Langer 1.833 1.483 2.265 5.608 0.000

2.423 2.159 2.719 15.060 0.000

0.01 0.1 1 10 100

Favours Maternal Non-obesity


Figure 3.2 Forest Plot for Large for Gestational Age (>90%ile)

Heterogeneity: Q=421.5, p=0.00, I2=97

OR 2.42 [95% CI 2.16, 2.78}

Study Quality

02468

1012

Number of Studies

Grading

Study Quality

HighModerateLow

Mother’s Weight and Birthweight ≥4000g,

By Study Quality

Group bySubgroup within study

Subgroup within study Statistics for each study Odds ratio and 95% CIOdds Lower Upper ratio limit limit Z-Value p-Value

High quality Bhattacharya High quality 2.168 1.886 2.493 10.875 0.000High quality 2.168 1.886 2.493 10.875 0.000Mod/low quality El-Gilany Mod/low quality 7.060 1.532 32.545 2.507 0.012Mod/low quality Stepan Mod/low quality 2.861 2.276 3.597 9.004 0.000Mod/low quality Van Wooten Mod/low quality 4.722 0.901 24.751 1.837 0.066Mod/low quality Mantakas Mod/low quality 2.204 1.739 2.793 6.537 0.000Mod/low quality Le Thai Mod/low quality 23.885 3.088 184.716 3.040 0.002Mod/low quality Brennand Mod/low quality 3.756 2.340 6.027 5.483 0.000Mod/low quality Crane Mod/low quality 1.861 1.469 2.359 5.143 0.000Mod/low quality Sukalich Mod/low quality 1.785 1.295 2.460 3.538 0.000Mod/low quality Jensen Mod/low quality 1.432 1.148 1.786 3.181 0.001Mod/low quality Baeten Mod/low quality 1.951 1.841 2.067 22.570 0.000Mod/low quality Driul Mod/low quality 2.576 1.073 6.187 2.117 0.034Mod/low quality Roman Mod/low quality 3.106 2.284 4.223 7.225 0.000Mod/low quality Sahu Mod/low quality 25.576 1.019 642.214 1.971 0.049Mod/low quality Rode Mod/low quality 1.881 1.525 2.319 5.909 0.000Mod/low quality Langer Mod/low quality 1.893 1.431 2.503 4.474 0.000Mod/low quality 2.189 1.898 2.525 10.758 0.000Overall 2.178 1.972 2.407 15.297 0.000

0.01 0.1 1 10 100



Figure 3.6 Macrosomia (>/= 4000g), Analysis by Study QualityGroup bySubgroup within study



0.01 0.1 1 10 100




0.01 0.1 1 10 100



Figure 3.6 Macrosomia (>/= 4000g), Analysis by Study Quality

Heterogeneity High Quality: Q=N/A, p=N/A, I2=N/AHeterogeneity Moderate/Low Quality: Q=47.6, p=0.00, I2=71Heterogeneity Overall: Q=48.8, p=0.00, I2=69

Mother’s Weight and Birthweight ≥4500g,

By Study Quality

Heterogeneity High Quality: Q=2.6, p=0.11, I2=62Heterogeneity Moderate/Low Quality: Q=8.3, p=0.14, I2=40Heterogeneity Overall: Q=13.5, p=0.06, I2=48

Mother’s Weight and Birthweight ≥90th percentile,

By Study Quality


Study name Subgroup within study Statistics for each study Odds ratio and 95% CIOdds Lower Upper ratio limit limit Z-Value p-Value

High Quality Narchi High Quality 2.468 2.107 2.890 11.205 0.000High Quality Lumme High Quality 2.777 2.117 3.644 7.374 0.000High Quality 2.543 2.218 2.915 13.393 0.000Mod/Low Quality Nohr Mod/Low Quality 2.743 2.519 2.986 23.231 0.000Mod/Low Quality Getahun Mod/Low Quality 2.061 1.973 2.152 32.709 0.000Mod/Low Quality Hoff Mod/Low Quality 0.860 0.367 2.018 -0.346 0.729Mod/Low Quality Magann Mod/Low Quality 2.721 2.066 3.583 7.127 0.000Mod/Low Quality Leung Mod/Low Quality 3.188 2.632 3.861 11.863 0.000Mod/Low Quality Bodnar Mod/Low Quality 4.328 3.886 4.821 26.635 0.000Mod/Low Quality Voigt Mod/Low Quality 2.452 2.387 2.519 65.143 0.000Mod/Low Quality Salihu Mod/Low Quality 1.964 1.929 2.000 72.996 0.000Mod/Low Quality Jensen Mod/Low Quality 1.606 1.266 2.038 3.903 0.000Mod/Low Quality Athukorala Mod/Low Quality 2.261 1.521 3.362 4.033 0.000Mod/Low Quality Langer Mod/Low Quality 1.833 1.483 2.265 5.608 0.000Mod/Low Quality 2.393 2.110 2.713 13.604 0.000Overall 2.420 2.166 2.720 19.080 0.000

0.01 0.1 1 10 100



Figure 3.5 Forest Plot for Large for Gestational Age (>90%ile), Analysis by Study QualityGroup bySubgroup within study

Study name Subgroup within study Statistics for each study Odds ratio and 95% CIOdds Lower Upper ratio limit limit Z-Value p-Value

High Quality Narchi High Quality 2.468 2.107 2.890 11.205 0.000High Quality Lumme High Quality 2.777 2.117 3.644 7.374 0.000High Quality 2.543 2.218 2.915 13.393 0.000Mod/Low Quality Nohr Mod/Low Quality 2.743 2.519 2.986 23.231 0.000Mod/Low Quality Getahun Mod/Low Quality 2.061 1.973 2.152 32.709 0.000Mod/Low Quality Hoff Mod/Low Quality 0.860 0.367 2.018 -0.346 0.729Mod/Low Quality Magann Mod/Low Quality 2.721 2.066 3.583 7.127 0.000Mod/Low Quality Leung Mod/Low Quality 3.188 2.632 3.861 11.863 0.000Mod/Low Quality Bodnar Mod/Low Quality 4.328 3.886 4.821 26.635 0.000Mod/Low Quality Voigt Mod/Low Quality 2.452 2.387 2.519 65.143 0.000Mod/Low Quality Salihu Mod/Low Quality 1.964 1.929 2.000 72.996 0.000Mod/Low Quality Jensen Mod/Low Quality 1.606 1.266 2.038 3.903 0.000Mod/Low Quality Athukorala Mod/Low Quality 2.261 1.521 3.362 4.033 0.000Mod/Low Quality Langer Mod/Low Quality 1.833 1.483 2.265 5.608 0.000Mod/Low Quality 2.393 2.110 2.713 13.604 0.000Overall 2.420 2.166 2.720 19.080 0.000

0.01 0.1 1 10 100



Figure 3.5 Forest Plot for Large for Gestational Age (>90%ile), Analysis by Study Quality

Heterogeneity High Quality: Q=0.5, p=0.46, I2=0Heterogeneity Moderate/Low Quality: Q=415.0, p=0.00, I2=97Hererogeneity Overall: Q=421.5, p=0.00, I2=97

Study Heterogeneity

Highly significant and important heterogeneity

LGA: Q=421.5, p=0.00, I2=97Macrosomia ≥4000g: Q=48.8, p=0.00, I2=69Macrosomia ≥4500g: Q=13.5, p=0.06, I2=48

Subgroups with decreased heterogeneityHigh quality studies only included (I2=0 for LGA)Use of measured height and weight (I2=14 for

macrosomia ≥4500g)

Cohort ObjectivesPrimary objective

Determine the combined effect of macrosomia and maternal obesity on adverse pregnancy outcomes

Secondary objectiveDescribe the occurrence of adverse pregnancy outcomes among macrosomic infants by maternal weight status

Cohort Methodology

Retrospective cohort database studyBORN dataset

Study populationMother-infant pairs with a macrosomic infant who delivered at the Ottawa Civic Hospital (December 2007-March 2010)

Cohort Methodology

Exposure variableMaternal pre-pregnancy BMI (obese vs. non-obese)

Outcome variablesMaternal intrapartum/

postpartumFetal/neonatal intrapartum/

resuscitation

Cohort Methodology

Primary Outcome VariableRate of Caesarean section (any indication)

Other Maternal OutcomesInduction of labour, labour augmentation, prolonged second stage, VAVD/FAVD, Caesarean section, regional analgesia

Fetal outcomesFetal monitoring, meconium, cord artery base excess >12.0, level of neonatal resuscitation

Cohort Methodology

Statistical Analyses

Descriptive: Fisher’s exact and t-test

Multivariate logistic regression modelling

Cohort Results: Maternal Outcomes

Macrosomia was common (835/6960 births =12%)

240/835 (29%) to obese mothers

Cohort Results: Cohort Demographics

Underweight(BMI < 18.50 kg/m2)

286 4.11%

Normal Weight(BMI 18.50-24.99 kg/m2)

3698 53.13%

Overweight(BMI 25.00-29.99 kg/m2)

1648 23.68%

Obese(BMI ≥ 30 kg/m2)

1328 19.08%

BMI of women delivering at the Ottawa Civic Hospital (December 2007 – March 2010)


Maternal BMI Class

Number Percent

Non-Macrosomic Infants

Underweight 272 4.4

Normal weight 3336 54.5

Overweight 1429 23.3

Obese 1088 17.8

Macrosomic Infants

Underweight 14 1.7

Normal weight 362 43.4

Overweight 219 26.2

Obese 240 28.7

Characteristics Macrosomic Infant,Non-obese Mothern=595

Macrosomic Infant, Obese Mothern=240

p-value

n (%) n (%)

Maternal age (y)<3030-39>40

NulliparityGestational age at delivery (weeks)BMI pre-pregnancyHeight (cm)Pre-pregnancy weight (kg)

178 (29.92)377 (63.36)40 (6.72)229 (38.49)

39.87 (1.05)24.06 (3.06)164.21 (6.84)67.54 (9.96)

84 (35.00)140 (58.33)16 (6.67)91 (37.92)

39.33 (1.25)36.46 (6.52)165.87 (7.90)100.68 (21.48)

0.160.181.000.94

<0.001<0.0010.003<0.001


Characteristics Macrosomic Infant,Non-obese Mothern=595

Macrosomic Infant, Obese Mothern=240

p-value

n (%) n (%)

Gestational diabetesGestational hypertensionEclampsiaSmoking in pregnancyMean birthweight (g)LGA (≥90th percentile)Macrosomia I (≥4000g)Macrosomia II (≥4500g)

16 (2.70)15 (2.53)0 (0)16 (2.69)4268 (233.15)407 (68.40)595 (100.0)94 (15.80)

28 (11.72)13 (5.44)0 (0)15 (6.25)4328 (276.44)202 (84.17)240 (100.0)60 (25.00)

<0.0010.051.000.020.002<0.0011.000.003



OutcomesMore likely to have:

Induced labour (AOR 1.42, 95% CI 1.10, 1.98)*Cesarean section

All indications (AOR 1.45, 95% CI 1.04, 2.01)*Maternal indications (AOR 3.70, 95% CI 1.47,

9.34)*

*Adjusted for maternal age, parity, gestational age smoking and infant sex


Macrosomic Infant of Non‐obese

Mothern=595

Macrosomic Infant of Obese

Mothern=240

Maternal Outcome Measure n (%) n (%) Crude OR 95% CI Adjusted OR¥

95% CI

Induction of labourInduction of labour for LGALabour augmentation with oxytocinProlonged second stage (>3h)Cesarean section delivery

All indicationsFailure to progress/descendNon‐reassuring fetal heart rateBreech presentationMaternal indication

Operative vaginal deliveryVacuum assisted vaginal deliveryVacuum or forceps assisted

AnesthesiaRegional

198 (33.28)53 (10.41)

145 (46.77)52 (13.79)

215 (36.20)84 (39.07) 33 (15.35) 12 (5.58) 8 (3.72)

40 (6.72) 43(7.22)

504 (84.71)

88 (36.67)27 (14.84)43 (46.24)16 (13.22)

119 (49.58)33 (27.73) 14 (11.76)

7 (5.88)15 (12.61)

13 (5.42) 14 (5.84)

206 (85.83)

1.161.500.980.95

1.730.600.741.063.73

0.800.80

1.06

0.85‐1.590.91‐2.470.62‐1.560.52‐1.74

1.28‐2.350.37‐0.970.38‐1.440.41‐2.761.53‐9.09

0.42‐1.510.43‐1.48

0.70‐1.60

1.42‡0.830.991.11

1.45‡0.750.900.783.70‡

0.850.86

0.88

1.10‐1.980.45‐1.560.59‐1.650.55‐2.22

1.04‐2.010.41‐1.370.44‐1.830.28‐2.141.47‐9.34

0.43‐1.650.45‐1.63

0.57‐1.37

¥Adjusted for maternal age, parity (0 vs ≥1), gestational age at delivery (continuous), smoking (yes vs no), infant sex (malevs female), gestational diabetes (yes vs no) and gestational hypertension (yes vs no)

Cohort Results: Fetal/Neonatal Outcomes

• No difference in intrapartum monitoring

• Macrosomic babies• Less likely to avoid resuscitation• AOR (0.64, 95% CI 0.43, 0.95)*• More likely to require free flow oxygen• AOR (1.57, 95% CI 1.03, 2.42)*

• Trend towards increased need for ventilation and intubation

*Adjusted for maternal age, parity, gestational age smoking and infant sex


Macrosomic Infant of

Non‐obese

Mothern=595

Macrosomic Infant of Obese

Mothern=240

n (%) n (%) Crude OR

95% CI Adjusted OR¥

95% CI

Intrapartum monitoringAuscultationInternal FMExternal FM

MeconiumCord artery base excess >12.0Delivery room resuscitation

requiredNo resuscitation Free flow oxygenPositive pressure ventilationIntubation

Stillbirth Neonatal mortality

Early (<7 days)Late (7‐28 days)

Perinatal mortalityStillbirth + neonatal death

458 (76.97)34 (5.71)

448 (75.29)101 (16.97)

48 (8.38)

502 (84.37)75 (12.61)42 (7.06)20 (3.36)

0 (0)

0 (0)0 (0)

0 (0)

198 (82.85)18 (7.53)

166 (69.46)39 (16.25)10 (4.27)

189 (78.75)42 (17.50)24 (10.0)11 (7.58)

0 (0)

0 (0)0 (0)

0 (0)

1.440.751.340.950.49

0.691.471.461.38N/A

N/AN/A

N/A

0.98‐2.130.54‐1.040.74‐2.430.63‐1.420.24‐0.98

0.47‐1.000.98‐2.220.87‐2.480.65‐2.93N/A

N/AN/A

N/A

1.320.901.551.210.48

0.64‡1.57‡1.571.68N/A

N/AN/A

N/A

0.89‐1.970.62‐1.300.84‐2.880.79‐1.860.23‐1.00

0.43‐0.951.03‐2.420.91‐2.710.77‐3.65N/A

N/AN/A

N/A

¥Adjusted for maternal age, parity (0 vs ≥1), gestational age at delivery (continuous), smoking (yes vs no), infant sex (male vs female), gestational diabetes (yes vs no) and gestational hypertension (yes vs no)


Macrosomic Infant of Obese Mother with Gestational Diabetes (n=28)

Macrosomic Infant of Obese Mother without Gestational Diabetes (n=211)

n (%) n (%) Crude OR 95% CI Adjusted OR* 95% CI

Cesarean delivery –

any indication

15 (53.57) 104 (49.29) 1.19 0.54 – 2.62 1.20 0.51 – 2.81

Cesarean delivery –maternal indication

4 (26.67) 11 (10.58) 3.08 0.84 – 11.33 2.41 0.58 – 9.92

*¥Adjusted for maternal age, parity (0 vs ≥1), gestational age at delivery (continuous),

smoking (yes vs no), infant sex (male vs female) and gestational hypertension (yes vs no)


Macrosomic Infant of Obese Mother

with Gestational Hypertension

(n=13)

Macrosomic Infant of Obese Mother without

Gestational Hypertension

(n=226)

n (%) n (%) Crude OR 95% CI Adjusted OR* 95% CI

Cesarean delivery –

any indication

5 (38.46) 114 (50.44) 0.61 0.20 – 1.93 0.43 0.13 – 1.43

Cesarean delivery –maternal indication

3 (60.00) 12 (10.53) 12.74 1.93 – 84.06 8.63 1.10 – 67.84

*¥Adjusted for maternal age, parity (0 vs ≥1), gestational age at delivery (continuous), smoking (yes vs no), infant sex (male vs female) and gestational diabetes (yes vs no)

Can we improve neonatal outcomes for these mothers and

infants?

1. Encourage a healthy lifestyle during pregnancy (diet + physical activity) = lower gestational weight gain

2. Anticipate fetal macrosomia among women who are obese, particularly if they are undergoing induction of labour or Cesarean section


infants?


infants?3. Recognize that a macrosomic infant from

an obese mother may be at higher risk of complications in the delivery room

Conclusions and Future Work1. Maternal obesity is clearly associated with fetal

overgrowth

2. There appears to be an additive effect of obesity and fetal overgrowth on adverse outcomes

Induction of labourCesarean section (overall and maternal indication)Need for neonatal resuscitation

Goals of future research → Decrease incidence of maternal obesity and macrosomia

Ron Mueck, 2006 “A Girl”

Acknowledgements

Thesis Supervisors:Dr. Mark WalkerDr. Shi Wu Wen

Others:Mr. Zach FerraroDr. Xiaowen Tu and Ms. Huiling CaoMs. Ann Sprague

Questions and Discussion

What to Expect When you’re Expecting an Infant from … you’re Expecting an Infant from a “Mother of Size ... Overall Obese Mothers Birthweight ≥ 4000g 10.4% 15.8% ... ratio

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