Effects of maternal obesity, excessive gestational weight gain and fetal macrosomia on the frequency of cesarean deliveries among migrant and non-migrant women - a prospective study

Gestational Weight Gain, Pregnancy Related Complications and the Short-Term Risks for the Offspring

BACKGROUND AND OBJECTIVES

Maternal obesity influences pregnancy course in several different manners, and imbalanced nutrition during pregnancy may lead to various adverse pregnancy outcomes. Additionally, nutritional status during pregnancy may have implications for the health of the offspring and may possibly influence early motor development in children. The aim of this study was to assess the impact of excessive gestational weight gain (EGWG) on pregnancy outcomes and infant's motor development within the first twelve months of life.

MATERIALS AND METHODS

The study included 200 participants divided in two groups based on their gestational weight gain. Maternal, perinatal, and neonatal factors were analyzed, and early motor development was assessed using the Alberta infant motor scale (AIMS).

RESULTS

EGWG was significantly associated with: pre-pregnancy BMI (p < 0.001), family history for cardiovascular diseases (p = 0.013) and diabetes mellitus (p = 0.045), hypertensive disorder of pregnancy (p = 0.003), gestational diabetes mellitus (p < 0.001), gestational anemia (p = 0.001), vitamin D deficiency (p = 0.001), metformin use (p = 0.045), pre-labor premature rupture of membranes (p = 0.031), amniotic fluid index (p = 0.047), and APGAR score in the first five min of life (p = 0.007). Scored by AIMS, EGWG was significantly associated with parameters of early motor development at the age of three AIMS total (p < 0.001), six AIMS total (p < 0.001), nine AIMS total (p < 0.001), and twelve AIMS total (p < 0.001) months of infant's life.

CONCLUSIONS

The link between EGWG and adverse neurodevelopmental outcomes in offspring is a complex and multifaceted issue. Our results imply significant alterations in early motor development in the group of infants born from mothers who gained weight excessively during pregnancy. Further studies are needed to unravel the intricacies of this relationship and inform strategies for preventive interventions and supportive care during pregnancy and infancy.

Elective Induction of Labor or Expectant Management: Outcomes Among Nulliparous Women with Uncomplicated Pregnancies

INTRODUCTION

Cesarean birth rates among women who are nulliparous with uncomplicated full-term pregnancies have been shown to decrease if labor is electively induced. The purpose of this study was to compare the cesarean birth rate for women with pregnancies at 39.0 weeks' gestation or later admitted for spontaneous labor or medically indicated induction of labor (IOL) with that of women receiving elective IOL at term.

METHODS

A retrospective cohort study was conducted by searching electronic health records of all nulliparous women with uncomplicated pregnancies who gave birth between January 2018 through February 2020 at one academic medical center. Select maternal demographic data and approach to labor management were the primary variables analyzed in determining the odds of cesarean birth.

RESULTS

A total of 1528 women were included in this study. Among these, 158 received elective IOL, and 1370 did not. The cesarean birth rates (31.0% vs 23.9%, elective induction of labor vs expectant management, respectively, P = .048), neonatal intensive care admissions (9.5% vs 7.6%, P = .41), and Apgar scores were similar among women in both management groups, respectively (P = .08). Accounting for other potential risk factors, the odds of having cesarean birth were not statistically different between management groups (adjusted odds ratio, 0.73; 95% CI, 0.5-1.1; P = .09). There were 2 fetal deaths among women whose labor was not electively induced. In the total cohort, women who were older, who had higher body mass index (BMI), and who identified as non-Hispanic Black had an increased odds of experiencing a cesarean birth. The associations between women in management groups and cesarean birth were not modified by age, BMI, race, or ethnicity (P = .33, .67, and .87, respectively).

DISCUSSION

Elective IOL was not associated with lower cesarean rates in this study. Further research is needed before implementing clinical practice changes that encourage more use of IOL.

Perinatales Outcome bei Frauen mit Gestationsdiabetes unter besonderer Berücksichtigung eines Migrationshintergrundes – Ergebnisse einer prospektiven Studie in Berlin

Hintergrund Etwa 25 % der Bevölkerung Deutschlands haben einen Migrationshintergrund (MH), der mit einem schlechteren perinatalen Outcome einhergehen kann. Der Gestationsdiabetes (GDM) gehört zu den häufigsten Schwangerschaftserkrankungen; von ihm sind Frauen mit MH in höherem Maße betroffen. Bisher liegen keine systematisch erhobenen Daten zur Betreuung von Migrantinnen mit GDM vor.

Fragestellung Ziel der Studie war es, Auswirkungen eines MH auf Schwangerschaften von Frauen mit GDM zu evaluieren: Haben Immigrantinnen und ihre Nachkommen ein schlechteres perinatales Outcome als Frauen ohne MH in den Parametern Geburtseinleitung, Sectio, Makrosomie, Apgar, Nabelschnur-pH-Wert, Verlegung auf eine neonatologische Intensivstation, Frühgeburt und prä-/postpartale Hb-Differenz? Beeinflusst ein MH außerdem den Zeitpunkt der ersten Schwangerenvorsorge sowie die Zahl der Vorsorgeuntersuchungen?

Methoden Datenerhebung an drei Berliner Geburtskliniken 2011/2012 unmittelbar in der Kreißsaalaufnahme über 12 Monate anhand standardisierter Interviews (Fragebogenset) in deutscher, türkischer und anderen Sprachen. Fragen zu soziodemografischen Aspekten, Schwangerenvorsorge sowie ggf. Migration und Akkulturation. Verknüpfung der Befragungsdaten mit Mutterpass- und klinischen Perinataldaten. Adjustierung für Alter, BMI, Parität und sozioökonomischen Status erfolgte in Regressionsmodellen.

Ergebnisse Die Daten von n = 2878 Frauen mit MH (GDM: 4,7 %) und n = 2785 Frauen ohne MH (GDM: 4,8 %) konnten verglichen werden. Eine multiple Regressionsanalyse zeigte keine Unterschiede in den Chancen der beiden Gruppen mit GDM hinsichtlich Sectio, Makrosomie, Apgar, Nabelschnur-pH-Werten, Verlegungen auf eine neonatologische Intensivstation sowie Zeitpunkt der ersten Schwangerenvorsorge ≥ 12 SSW und Zahl der Vorsorgeuntersuchungen < 10. Sowohl für Frauen mit GDM und MH (OR 1,57; 95 %-KI 1,08–2,27) als auch für solche mit GDM ohne MH (OR 1,47; 95 %-KI 1,01–2,14) bestand eine signifikant höhere Chance der Geburtseinleitung.

Schlussfolgerung Frauen mit GDM und MH zeigen ein ähnlich gutes Schwangerschaftsergebnis wie solche mit GDM und ohne MH, was auf eine hohe Qualität der peripartalen Betreuung und Versorgung hinweist. Im Vergleich zu Frauen ohne GDM wird bedingt durch diesen und den höheren BMI unabhängig vom MH vermehrt eingeleitet. Die Ergebnisse für Frauen mit GDM lassen unabhängig vom MH auf einen ähnlichen Standard der Inanspruchnahme von Vorsorgeuntersuchungen in der Schwangerschaft schließen.

Association between Maternal Origin, Pre-Pregnancy Body Mass Index and Caesarean Section: A Nation-Wide Registry Study

Aims: To explore the association between maternal origin and birthplace, and caesarean section (CS) by pre-pregnancy body mass index (BMI) and length of residence. Methods: We linked records from 118,459 primiparous women in the Medical Birth Registry of Norway between 2013 and 2017 with data from the National Population Register. We categorized pre-pregnancy BMI (kg/m²) into underweight (<18.5), normal weight (18.5–24.9) and overweight/obese (≥25). Multinomial regression analysis estimated crude and adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) for emergency and elective CS. Results: Compared to normal weight women from Norway, women from Sub-Saharan Africa and Southeast Asia/Pacific had a decreased risk of elective CS (aRRR = 0.57, 95% CI 0.37–0.87 and aRRR = 0.56, 0.41–0.77, respectively). Overweight/obese women from Europe/Central Asia had the highest risk of elective CS (aRRR = 1.42, 1.09–1.86). Both normal weight and overweight/obese Sub-Saharan African women had the highest risks of emergency CS (aRRR = 2.61, 2.28-2.99; 2.18, 1.81-2.63, respectively). Compared to women from high-income countries, the risk of elective CS was increasing with a longer length of residence among European/Central Asian women. Newly arrived migrants from Sub-Saharan Africa had the highest risk of emergency CS. Conclusion: Women from Sub-Saharan Africa had more than two times the risk of emergency CS compared to women originating from Norway, regardless of pre-pregnancy BMI.

[Pregnant Women with Gestational Diabetes in Berlin - An Analysis of Perinatal Data Especially Regarding Immigration Background]

To date there has not been a systematic analysis of pregnant patients with an immigrant background and gestational diabetes in Germany, even though the number of these patients has been rising continuously since the 1980s.

METHODS

The case number estimate for this prospective study targeted 160 patients with gestational diabetes with and without an immigrant background. A questionnaire on socio-economic status, immigrant background, acculturation, and food intake was developed. The birth parameters and pre- and postpartum parameters were regularly documented.

RESULTS

In our study we included 198 patients with gestational diabetes, consisting of 110 patients with an immigrant background and 88 patients without an immigrant background. The number of labor inductions for the suspected diagnosis of fetal macrosomia was almost the same in both groups (immigrant background 3.6% vs. without immigrant background 4.6%, p=1.0; OR 1.73; 95% CI; 0.79-3.89, p=0.17). The study patients with an immigrant background were more likely to give birth spontaneously than via cesarean section or vaginal-operative birth. The perinatal outcome of children from our study patients with and without an immigrant background were similar.

CONCLUSION

We show that regardless of their immigrant background gestational diabetes patients have similar and homogeneous patient-centered care at our clinic.