The research evaluates neonatal outcomes for pregnancies complicated by maternal obesity

Obesity is associated with many adverse health outcomes, including during pregnancy. However, there is little information about the impact of maternal obesity on neonatal mortality and morbidity.

A recent study published in American Journal of Obstetrics and Gynecology The association of maternal body mass index (BMI) in pregnancy with neonatal outcome is discussed. More specifically, the researchers were interested in determining whether maternal obesity increases the risk of poor newborn outcomes, regardless of the presence of pre-existing diabetes and chronic high blood pressure.

Study: Short-term neonatal outcomes of pregnancy complicated by maternal obesity.  Image credit: FotoDuets/

Stady: Short-term neonatal outcomes of pregnancy complicated by maternal obesity. Image credit: FotoDuets/

an introduction

Maternal obesity is relatively common during pregnancy, with about one-third of pregnancies in the United States having obesity. Obesity is linked to maternal high blood pressure, diabetes, and pre-eclampsia, as it is a chronic inflammatory condition.

During pregnancy, obese mothers are at higher risk of miscarriage and stillbirth, with babies born to such mothers at greater risk of congenital anomalies, gigantism, shoulder dystocia, neonatal death, and meconium aspiration.

The current study investigates how maternal obesity affects neonatal health and mortality. Here, the scientists used data from a cohort of single births from 24-42 weeks gestation at 25 hospitals between 2008-2011.

The mother’s BMI was classified into the normal/overweight reference group. The experimental groups were classified as morbidly obese (OB), morbidly obese (MO), and morbidly obese (SMO) on the basis of BMI, with values ​​ranging from 30–39.9 kg/m.240-49.9 kg / m2and 50 kg / m2 or more in a row. Reference BMI values ​​ranged from 18.5-29.9 kg/m2.

All patients in the reference and other groups were matched for baseline characteristics such as age, race, ethnicity, chronic hypertension, diabetes, and previous caesarean section, along with cigarette use and insurance status.

Scientists evaluated neonatal death, hypoxic encephalopathy (HIE), respiratory distress syndrome, and other newborn complications. Preterm labor, defined as delivery before gestational week 37, was also included, as were pre-eclampsia and maternal pre-eclampsia.

What did the study show?

The current study included more than 52,000 patients and neonates, of which 42% were OBs, and 7% and 1% were born and Zimbabwean, respectively. Obesity, pre-existing diabetes, chronic hypertension, and cigarette use were associated with an increase in body mass index, albeit at a lower rate compared to the control group.

Hispanics were significantly overrepresented in the OB group, while black mothers were overrepresented in the MO and SMO groups, which also had a higher proportion of women with a history of caesarean section. Pre-eclampsia, preeclampsia, and caesarean section have been reported more frequently with increased BMI.

Premature births were least likely in the OB group but increased from OB to SMO at <37 weeks and <28 weeks' gestation. Birth weights tend to increase with maternal BMI, with the baby more likely to be over 4 kg in pregnancies in OB, MO and SMO mothers. These children were more likely to have a birth defect.

The risk of neonatal morbidity increased by one-third in neonates born to MO mothers compared with those born to women in the control group. However, no such association was observed for children born to OB or SMO mothers. Pre-existing obesity and obesity in early pregnancy may predict an increased risk of a more significant neonatal morbidity.

What are the effects?

Serious neonatal morbidity was higher in infants born to MO mothers than in those in the control group, even after allowing for the confounding effects of maternal diabetes, preeclampsia, and preterm birth.

However, neonatal mortality did not increase in agreement with maternal BMI. Moreover, the combined morbidity did not increase among neonates with higher BMI, provided chronic hypertension and pre-existing diabetes were present.

Babies born to MO and SMO mothers were more likely to weigh more than 4 kg and have congenital disabilities, confirming previous reports. However, while it has been previously observed that preterm birth is more common in infants born to obese mothers, there is some debate as to the validity of this finding, as the current study reports fewer preterm births among obese mothers. Conversely, the risk of preterm birth at less than 37 weeks and less than 28 weeks increases with increasing BMI.

The reasons behind the increased rates of neonatal morbidity in the short term among children born to obese mothers have not yet been established; However, normalizing BMI before pregnancy, in addition to controlling chronic hypertension and diabetes mellitus, may help prevent or mitigate the adverse effect of obesity on neonatal outcome.

Journal reference:

  • Dinsmoor, MJ, Ugwu, LG, Bailit, JL, et al. (2023). Short-term neonatal outcomes of pregnancy complicated by maternal obesity. American Journal of Obstetrics and Gynecology. doi: 10.1016/j.ajogmf.2023.100874.

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