|Year : 2018 | Volume
| Issue : 4 | Page : 213-216
Hostile turf: Higher maternal body mass index and neonatal intensive care unit admission risk
Aditi Saini, Syed Masuma Rizvi, Anumodan Gupta
Department of Obstetrics and Gynecology, GMC, Srinagar, Jammu and Kashmir, India
|Date of Web Publication||15-Oct-2018|
Dr. Anumodan Gupta
Government Medical College, Jammu - 180 001, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Background: Body mass index (BMI) helps in the evaluation of obesity in pregnancy. Objective: The objective of the present study was to determine association between maternal BMI and neonates requiring the neonatal Intensive Care Unit (NICU) admission. Materials and Methods: All obstetric patients who were admitted for obstetric intervention in the third trimester between April 1, 2014, and September 30, 2015, were studied. Patients with singleton pregnancy gestational age more than 35 weeks were included in the study and multifetal gestation a known case of Type 2 diabetes mellitus (DM) and chronic hypertension were excluded from the study. Patients were divided into four groups on the basis of BMI; in all these groups, maternal and fetal outcome was studied. Results: According to BMI, 22.4% of patients were obese and 35.3% of patients were of normal BMI. Gestational DM, pregnancy-induced hypertension (PIH), and preeclampsia remained statistically significant high in obese and overweight group as compared to women with normal BMI. There was no significant association between antepartum hemorrhage, intrauterine growth restriction, malpresentation, and preterm between obese and nonobese groups. NICU admission rate was significantly associated with maternal obesity. For BMI and NICU admissions, relative risk (RR) in underweight versus healthy was 6.00 (P = 0.011, confidence interval 1 [CI1]:.29–27.76). In comparing women with BMI <30 to women with BMI ≥30, newborns of obese women were 5.9% more likely to need NICU admission (RR: 1.336, P = 0.04, CI: 1.021–1.749). Conclusion: This study showed an increased risk of wide variety of pregnancy and perinatal complications and higher neonatal admissions in overweight and obese women.
Keywords: Body adiposity index, cesarean delivery, instrumental delivery, obesity, overweight
|How to cite this article:|
Saini A, Rizvi SM, Gupta A. Hostile turf: Higher maternal body mass index and neonatal intensive care unit admission risk. J Clin Neonatol 2018;7:213-6
|How to cite this URL:|
Saini A, Rizvi SM, Gupta A. Hostile turf: Higher maternal body mass index and neonatal intensive care unit admission risk. J Clin Neonatol [serial online] 2018 [cited 2018 Nov 13];7:213-6. Available from: http://www.jcnonweb.com/text.asp?2018/7/4/213/243331
| Introduction|| |
Obesity in adults is a complex disorder. Many factors, including genetics, environment, metabolism, lifestyle, and eating habits, are believed to play a role in the development of obesity. It is a major health problem in both the developed and developing countries across the globe. Obesity is associated with the risk of cardiac diseases, hypertension, diabetes mellitus (DM), and other so many complications.,, Obesity during pregnancy increases morbidity and mortality for both mother and offspring.,, It envisages adverse outcomes during pregnancy and delivery which include increased gestational DM (GDM), pregnancy-induced hypertension (HTN), preeclampsia (PEC), and cesarean delivery, postpartum hemorrhage, postpartum wound soakage, and similarly, adverse neonatal outcomes include increased frequency of fetal anomalies, microsomia, and increased admission to the neonatal Intensive Care Unit (NICU)., One of the most widely used indices in the evaluation of obesity in pregnancy is the body mass index (BMI). On the basis of the above knowledge and literature, we hypothesized that there is an association between maternal BMI and neonates requiring NICU admission. The objective of the study was to determine association between maternal BMI and neonates requiring NICU admission. It was a prospective observational study, and maternal conditions associated with obesity, i.e., GDM, HTN, PEC, and hypothyroidism or a combined contribution of these risk factors were also studied.
| Materials and Methods|| |
The present study was conducted at tertiary care center in Srinagar, Jammu and Kashmir, India. The study period was of 1½ years. All obstetric patients who were admitted to labor room and ward for obstetric intervention in the third trimester between April 1, 2014, and September 30, 2015, were taken as study participants after fulfilling inclusion criteria. They were enrolled in the study after their written informed consent. Patients with singleton pregnancy gestational age more than 35 weeks were included in the study and multifetal gestation and a known case of Type 2 DM and chronic hypertension were excluded from the study. A detailed history was taken. General physical examination was carried out. All routine investigations and any investigation about the patient were done. After detailed history and examination and after fulfilling the criteria for inclusion in the study, anthropometric measurements were carried out on the patient. Weight was measured using Equinox electronic machine (Model: EB-EQ11), to the nearest 100 g with patients in light clothing, and height (stature) was measured without shoes and heel against the wall and head in the plan to the nearest centimeter using the height measure stadiometer to the nearest 0.1 cm. Patients were divided into four groups on the basis of BMI as follows: Group 1 (underweight) – this group included patients having BMI <18.5, Group 2 (healthy) – this group included patients having BMI 18.5–24.9, Group 3 (overweight) – this group included patients having BMI 25–29.9, and Group 4 (obese) – this group included patients having BMI >30. In all these groups, the maternal and fetal outcome was studied along the following lines: abnormal glucose tolerance test and GDM, PIH and PEC, preterm, intrauterine growth restriction (IUGR). Antepartum hemorrhage (APH), malpresentations, mode of delivery, intrapartum complications, postpartum complications, and neonatal outcome in terms of birth weight, Apgar scoring, and neonatal admissions if any. GDM was diagnosed according to the guidelines by the American Diabetes Association 23. Maternal hematocrit was defined by the mother's medical history or by a systolic blood pressure ≥140 mmHg or a diastolic blood pressure ≥90 mmHg based on at least two separate occasions before 20 weeks. PEC was defined by new-onset hypertension (systolic blood pressure ≥140 mmHg or diastolic ≥90 mmHg on at least two separate occasions) and proteinuria (≥300 mg in a 24-h collection or ≥1+ on a catheterized urine specimen in the acute setting) after 20 weeks according to the guidelines from the American College of Obstetricians and Gynecologists.
Data were entered in Microsoft Excel and SPSS 21, IBM, Armonk, NY, United States of America. Quantitative data were summarized as mean and standard deviation. Categorical data were summarized as percentages. Statistical hypothesis test included the Chi-square test or Fisher's exact test, whichever appropriate was applied. P < 0.05 was taken as statistically significant. Multiple logistic regressions were performed to analyze possible confounders of GDM, HTN, and PEC.
| Results|| |
Of the 1000 study participants, average weight of Kashmiri women presenting during late pregnancy and labor was 64.3 ± 10.63 kg. According to BMI, 41.5% and 22.4% of patients were overweight and obese, respectively. Nearly 50% of women in the underweight group were in the age group of 20–25 years, whereas 21.4% of obese patients were >35 years of age. GDM among the obese group was 14.3%. PIH and PEC remained statistically significantly high in the obese and overweight group. The frequency of PEC was 27.7% (BMI >30), whereas it was 7.9% in Group 2. Gestational hypertension was 29.0% in the Group 4 (BMI >30), whereas it was 8.5% in Group 2 (BMI18.5-24.9). There was no significant association between APH, IUGR, malpresentation, and preterm between obese and nonobese groups. About 58% of patients among the obese group had lower segment cesarean section (LSCS), whereas 30.3% of patients with normal BMI had LSCS. Nearly 68.6% of patients in the normal BMI group had vaginal delivery and 40.2% of patients in the obese group had vaginal delivery, shows birth weight of neonates in women of different BMI groups. Macrosomia was 21.4% in the Group 4 as compared to 10.8% in Group 2, and 50% of neonates had birth weight <2.5 kg among women with BMI in the underweight group. NICU admission rate was significantly associated with maternal obesity. NICU admission was seen in 26% and 22.3% of infant of overweight and obese women, respectively, with statically significance of <0. 001. While evaluating, BMI for NICU admissions, relative risk (RR) in underweight versus healthy was 6.00 (P = 0.011, confidence interval 1 [CI1].29-27.76) and newborns of obese women were 5.9% more likely to need NICU admission (RR: 1.336, P = 0.04, CI: 1.021–1.749). However, NICU admission rate was not associated with DM, HT, PEC, and hypothyroid (P ≥ 0.005) after logistic regression analysis.
| Discussion|| |
This prospective observational study was done from April 1, 2014, and September 30, 2015, at tertiary care hospital of Kashmir, India, and we found high prevalence of late preterm and term neonates requiring NICU admissions delivered to obese women. About 58% of patients had LSCS in obese mothers while 40.2% had vaginal delivery. Low birth weight babies (50%) were more in underweight while of macrosomic babies (21.4%) were more in obese women and were statistically significant, and results were similar to previous studies.,,,,,, No significant association was seen between IUGR, malpresentation, and preterm between obese and nonobese groups. NICU admission was seen in 26% and 22.3% in overweight and obese women, respectively, with (P < 0. 001). Newborns of obese women were 5.9% more likely to need NICU admission (RR: 1.336, P = 0.04, CI: 1.021–1.749) However, NICU admission rate was not associated with maternal DM, HT, PEC, and hypothyroid (P ≥ 0.005) after logistic regression analysis. Our study limitation was as, we did not assess the causes of neonatal admission, namely, hypoglycemia, sepsis, IUGR, critical cyanotic heart diseases, and metabolic disorders of newborn; moreover, serial BMI readings could have been better during antenatal period rather than single reading of at admission BMI. The strength of our study was that it is population based with a low rate of missing data and a large set of covariates. Our findings were similar to other studied but large sample size and mother with more of meat-eating population and larger weight babies as compared to other studies.
NICU admission of neonates was significantly increased among obese women in our study, and results are homogeneous to previous literature. The reason for this increased rate of neonatal complications in obese women is unknown but could be related to increased maternal pelvic soft tissue, as well as difficulty in estimating the fetal weight and intrapartum complications such as inability to adequately monitor the fetus and contractions., In our hospital, the total number of deliveries in the year 2014–2015 was 4528, and a total of 1000 deliveries were prospectively observed. NICU admission was seen in 26% and 22.3% in overweight and obese women, respectively, with (P < 0. 001). A study published in 2013 by Anne-Frederique Minsart, neonatal outcomes in obese mothers: a population-based analysis found that the prevalence of 1 min Apgar score <7 was observed in 6.9% and 9.1% and NICU admissions in 10% of cases of nonobese mother and 15.4% in obese mothers [Table 1] and [Table 2].
|Table 2: Apgar scoring and NICU admission of neonates among women of different BMI groups|
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In agreement with our observations, the neonatal admission for intensive care was significantly increased in obese mothers in a meta-analysis including four studies, and a higher rate of admission to NICU in obese women has been previously observed in Europe, USA, Canada, and Australia,,,,,,,,, even in term births. However, most of these studies only adjusted for a small set of covariates such as age and parity or used weight categories rather than BMI. Apgar scores were rarely reported.,,
| Conclusion|| |
Our study showed an increased risk of wide variety of pregnancy and perinatal complications and higher neonatal admissions in overweight and obese women which confers and extends the result of most of other studies.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Galtier-Dereure F, Boegner C, Bringer J. Obesity and pregnancy: Complications and cost. Am J Clin Nutr 2000;71:1242S-8S.
Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA 2012;307:491-7.
American College of Obstetricians and Gynecologists. ACOG committee opinion no 549: Obesity in pregnancy. Obstet Gynecol 2013;121:213-7.
Usha Kiran TS, Hemmadi S, Bethel J, Evans J. Outcome of pregnancy in a woman with an increased body mass index. BJOG 2005;112:768-72.
Sarkar RK, Cooley SM, Donnelly JC, Walsh T, Collins C, Geary MP, et al.
The incidence and impact of increased body mass index on maternal and fetal morbidity in the low-risk primigravid population. J Matern Fetal Neonatal Med 2007;20:879-83.
Raja UA, Mcaree T, Bassett P, Sharma S. The implications of a raised maternal BMI: A DGH experience. J Obstet Gynaecol 2012;32:247-51.
Langer O, Yogev Y, Xenakis EM, Brustman L. Overweight and obese in gestational diabetes: The impact on pregnancy outcome. Am J Obstet Gynecol 2005;192:1768-76.
Stevens J, Cai J, Evenson KR, Thomas R. Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study. Am J Epidemiol 2002;156:832-41.
Bhattacharya S, Campbell DM, Liston WA, Bhattacharya S. Effect of body mass index on pregnancy outcomes in nulliparous women delivering singleton babies. BMC Public Health 2007;7:168.
Ehrenthal DB, Jurkovitz C, Hoffman M, Jiang X, Weintraub WS. Prepregnancy body mass index as an independent risk factor for pregnancy-induced hypertension. J Womens Health (Larchmt) 2011;20:67-72.
Robinson BK, Mapp DC, Bloom SL, Rouse DJ, Spong CY, Varner MW, et al.
Increasing maternal body mass index and characteristics of the second stage of labor. Obstet Gynecol 2011;118:1309-13.
Verma A, Shrimali L. Maternal body mass index and pregnancy outcome. J Clin Diagn Res 2012;6:1531-3.
Pevzner L, Powers BL, Rayburn WF, Rumney P, Wing DA. Effects of maternal obesity on duration and outcomes of prostaglandin cervical ripening and labor induction. Obstet Gynecol 2009;114:1315-21.
Sujatha VV, Narasimha Sharma KV, Rajesh K. High body mass index in pregnancy, its effects on maternal and fetal outcome. J Clin Gynecol Obstet 2012;1:15-8.
Yazdani S, Yosofniyapasha Y, Nasab BH, Mojaveri MH, Bouzari Z. Effect of maternal body mass index on pregnancy outcome and newborn weight. BMC Res Notes 2012;5:34.
Scott-Pillai R, Spence D, Cardwell CR, Hunter A, Holmes VA. The impact of body mass index on maternal and neonatal outcomes: A retrospective study in a UK obstetric population, 2004-2011. BJOG 2013;120:932-9.
Minsart AF, Buekens P, De Spiegelaere M, Englert Y. Neonatal outcomes in obese mothers: A population-based analysis. BMC Pregnancy Childbirth 2013;13:36.
Heslehurst N, Simpson H, Ells LJ, Rankin J, Wilkinson J, Lang R, et al.
The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: A meta-analysis. Obes Rev 2008;9:635-83.
Raatikainen K, Heiskanen N, Heinonen S. Transition from overweight to obesity worsens pregnancy outcome in a BMI-dependent manner. Obesity (Silver Spring) 2006;14:165-71.
Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, et al
. Maternal obesity and pregnancy outcome: A study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001;25:1175-82.
Callaway LK, Prins JB, Chang AM, McIntyre HD. The prevalence and impact of overweight and obesity in an Australian obstetric population. Med J Aust 2006;184:56-9.
Perlow JH, Morgan MA, Montgomery D, Towers CV, Porto M. Perinatal outcome in pregnancy complicated by massive obesity. Am J Obstet Gynecol 1992;167:958-62.
Rosenberg TJ, Garbers S, Chavkin W, Chiasson MA. Prepregnancy weight and adverse perinatal outcomes in an ethnically diverse population. Obstet Gynecol 2003;102:1022-7.
Bianco AT, Smilen SW, Davis Y, Lopez S, Lapinski R, Lockwood CJ, et al
. Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstet Gynecol 1998;91:97-102.
Kalk P, Guthmann F, Krause K, Relle K, Godes M, Gossing G, et al
. Impact of maternal body mass index on neonatal outcome. Eur J Med Res 2009;14:216-22.
Abenhaim HA, Kinch RA, Morin L, Benjamin A, Usher R. Effect of prepregnancy body mass index categories on obstetrical and neonatal outcomes. Arch Gynecol Obstet 2007;275:39-43.
Lumme R, Järvelin MR, Rantakallio P, Hartikainen-Sorri AL. The starting time of prenatal care and pregnancy outcome. Duodecim 1993;109:309-16.
Ovesen P, Rasmussen S, Kesmodel U. Effect of prepregnancy maternal overweight and obesity on pregnancy outcome. Obstet Gynecol 2011;118:305-12.
[Table 1], [Table 2]