Mode of delivery after induction of labour in pregnant women with pre-pregnancy overweight and obesity.

Abstract

Background: The proportion of pregnant women with overweight or obesity whose labour is induced is increasing. The aim of this study was to examine the relationship between pre-pregnancy body mass index (BMI) and mode of delivery among pregnant women whose labour was induced.

Material and method: The study included women with singleton pregnancies, a fetus in cephalic presentation and a liveborn child, whose labour was induced at the University Hospital of North Norway, Tromsø in the period 2016-18. The mode of delivery was compared for women with a pre-pregnancy BMI < 25 kg/m2, overweight (BMI 25.0-29.9 kg/m2) and obesity (BMI ≥ 30 kg/m2).

Results: In the study, we included 807 women whose labour was induced. Of these, 402 had a pre-pregnancy BMI < 25 kg/m2, 202 had overweight and 203 had obesity. Of these, 306 (76.1 %), 149 (73.8 %) and 140 (69.0 %) had a spontaneous birth, while 60 (14.9 %), 40 (19.8 %) and 44 (21.7 %) had a caesarean section. As pre-pregnancy BMI increased, the proportion of spontaneous births decreased (p = 0.06), while the proportion delivered by caesarean section increased (p = 0.03). Women with obesity whose labour was induced were at a higher risk of caesarean section (odds ratio 1.6 (95 % confidence interval 1.0-2.4)) compared to those with a BMI < 25 kg/m2. After adjusting for age, height, prolonged rupture of membranes, parity and previous mode of delivery, the odds ratio remained virtually unchanged, but was no longer statistically significant (odds ratio 1.5 (95 % CI 0.9-2.4)).

Interpretation: Pre-pregnancy obesity was linked to a higher risk of caesarean section following induced labour, but the risk was more significantly influenced by being primiparous or multiparous without a prior vaginal delivery than by obesity itself.