Introduction
Obesity is a global epidemic. Data from the United Kingdom and Australia have demonstrated that women with a pre-pregnancy body mass index (BMI) greater than 50 kg/m2 or weight > 140 kg have poor maternal and neonatal outcomes [1,2].
Objectives
This retrospective audit aimed to assess the effect of severe obesity on maternal and neonatal outcomes at the Royal Brisbane and Women’s Hospital (RBWH) and compare these with published data from Australia and the UK.
Methods
Ethics exemption was obtained. Women were included if they delivered between January 2013 and December 2017 and had a booking weight > 140kg or body mass index (BMI) greater than 50 kg/m2. Data regarding maternal, antenatal and fetal outcomes was collected by chart review.
Results
Our sample included 127 women a mean age (SD) of 30.2 (5.81) years; 83 (65%) were nulliparous and 99 (78%) were Caucasian. The median (IQR, range) booking weight was 144 (140-156, 66-212) kg, BMI was 51.9 (49.1-55.6, 42.2-73.9) kg/m2 and gestation was 38.5 (38.1-39.3) weeks. Outcome data is summarised in Table 1. Fifteen women (12%) received antenatal thromboprophylaxis, while 98 (77%) received postnatal thromboprophylaxis. Three women (2.3%) had post-partum wound infections. On discharge, 104 (82%) women were breast feeding or combined breast feeding/formula feeding.
Conclusion
Caesarean section rates in our institution are consistent with published data. Comparatively more neonates and fewer women were admitted to intensive care units. Our population had higher rates of gestational diabetes, gestational hypertension, post-natal thromboprophylaxis and lower rates of macrosomic neonates. Women with severe maternal obesity have high rates of adverse maternal and fetal outcomes.
Table 1: Maternal, neonatal and anaesthesia outcomes for 127 obese women delivering at the Royal Brisbane and Women’s Hospital.
|
Outcome variables |
RBWH Audit (2013-18) |
Knight et al. (2010) |
Sullivan et al. (2015) |
|
Number of obese women |
127 |
665 |
370 |
|
Country of study |
Brisbane, Australia |
UK |
Australia and New Zealand |
|
BMI kg/m2 median (IQR) |
51.9 (42.2-73.9) |
53 (50-80) |
52.8 (40.9-79.9) |
|
Caesarean delivery n (%) |
79 (62%) |
50% |
51.6% |
|
General anaesthesia n (%) |
10 (7.8%) |
6% |
9.9% |
|
Maternal Outcomes n (%) |
|||
|
Gestational hypertension |
25 (19.7%) |
6.5% |
12.3% |
|
Pre-eclampsia |
14 (11%) |
9% |
8.5% |
|
Gestational diabetes |
58 (46%) |
11% |
15.6% |
|
ICU / HDU admission |
2 (1.6%) |
3% |
6.2% |
|
Neonatal Outcomes n (%) |
|||
|
Birth weight > 4500g |
8 (6.2%) |
10.1% |
|
|
Apgar score < 7 at 1 min |
21 (16%) |
||
|
BSL <2.6 mm/L |
47 (36%) |
||
|
NICU/SCN admission |
65 (50%) |
23.7% |
RBWH: Royal Brisbane & Women’s Hospital; BMI: Body mass index; ICU: Intensive care unit; HDU: High dependency unit; BSL: Blood sugar level; NICU: Neonatal intensive care unit; SCN: Special care nursery