Relation between perinatal outcome and gestational duration in term primiparous pregnancies stratified by body mass index
Abstract Introduction There is growing evidence that induction of labor at 41 completed weeks improves neonatal outcome, at least among primiparous women. This study was performed to investigate whether maternal body mass index (BMI) should be considered when deciding on timing of intervention in te...
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Wiley
2022-12-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14465 |
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| author | Lina Lindegren Andrea Stuart Andreas Herbst Karin Källén |
| author_facet | Lina Lindegren Andrea Stuart Andreas Herbst Karin Källén |
| author_sort | Lina Lindegren |
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| description | Abstract Introduction There is growing evidence that induction of labor at 41 completed weeks improves neonatal outcome, at least among primiparous women. This study was performed to investigate whether maternal body mass index (BMI) should be considered when deciding on timing of intervention in term pregnancies. Material and methods The study design was a historical cohort study using data from the Swedish Medical Birth Register, singletons in cephalic presentation with births 39+0 to 41+6 weeks, with available information on maternal BMI 2005–2017 (n = 352 567). Modified Poisson regression analyses were used to investigate the association between gestational duration and stillbirth or death before 45 postmenstrual weeks (primary outcome) and Apgar score <7 at 5 minutes (secondary outcome) by BMI, respectively. Adjustments were made for maternal age, smoking, country of birth and educational level. Results The adjusted relative risk (ARR) of stillbirth or death before 45 weeks among infants born at 41+0 to 41+6 vs 40+0 to 40+6 weeks, was 1.26 with a 95% confidence interval (CI) of 1.07–1.48. Among women with BMI ≥30, the offspring mortality risk in pregnancies lasting 39+0 to 39+2 weeks was significantly above the corresponding risk among women of normal BMI who delivered at 41+0 to 41+2 weeks (ARR = 1.95; 95% CI 1.07–3.56) but no statistically significant heterogeneity was found regarding the magnitude of the association between gestational duration and offspring mortality. The ARR, for Apgar <7 at 5 minutes (41+0 to 41+6 vs 40+0 to 40+6 weeks, regardless of BMI), was 1.36 (95% CI 1.27–1.45). The risk for low Apgar score at 41+0 weeks was 1.5% among all children regardless of maternal BMI. Among children to women with BMI ≥30, this magnitude of risk was found already at 39+3 weeks. Conclusions In primiparous women with obesity the risk of stillbirth or death before 45 postmenstrual weeks were increased throughout all full‐term gestational age categories, compared with women with overweight or normal BMI. Children to obese women had the same risk for Apgar scores <7 at 5 minutes compared with women overall at earlier gestational age. The results suggest that maternal BMI needs to be considered when discussing timing of elective induction in term healthy pregnancies of primiparous women. |
| format | Article |
| id | doaj-art-0ca5f7e68d2d40ca8cb44853697213fd |
| institution | OA Journals |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-0ca5f7e68d2d40ca8cb44853697213fd2025-08-20T02:09:35ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122022-12-01101121414142110.1111/aogs.14465Relation between perinatal outcome and gestational duration in term primiparous pregnancies stratified by body mass indexLina Lindegren0Andrea Stuart1Andreas Herbst2Karin Källén3Institution of Clinical Sciences, Department of Obstetrics and Gynecology Lund University Lund SwedenInstitution of Clinical Sciences, Department of Obstetrics and Gynecology Lund University Lund SwedenInstitution of Clinical Sciences, Department of Obstetrics and Gynecology Lund University Lund SwedenInstitution of Clinical Sciences, Department of Obstetrics and Gynecology Lund University Lund SwedenAbstract Introduction There is growing evidence that induction of labor at 41 completed weeks improves neonatal outcome, at least among primiparous women. This study was performed to investigate whether maternal body mass index (BMI) should be considered when deciding on timing of intervention in term pregnancies. Material and methods The study design was a historical cohort study using data from the Swedish Medical Birth Register, singletons in cephalic presentation with births 39+0 to 41+6 weeks, with available information on maternal BMI 2005–2017 (n = 352 567). Modified Poisson regression analyses were used to investigate the association between gestational duration and stillbirth or death before 45 postmenstrual weeks (primary outcome) and Apgar score <7 at 5 minutes (secondary outcome) by BMI, respectively. Adjustments were made for maternal age, smoking, country of birth and educational level. Results The adjusted relative risk (ARR) of stillbirth or death before 45 weeks among infants born at 41+0 to 41+6 vs 40+0 to 40+6 weeks, was 1.26 with a 95% confidence interval (CI) of 1.07–1.48. Among women with BMI ≥30, the offspring mortality risk in pregnancies lasting 39+0 to 39+2 weeks was significantly above the corresponding risk among women of normal BMI who delivered at 41+0 to 41+2 weeks (ARR = 1.95; 95% CI 1.07–3.56) but no statistically significant heterogeneity was found regarding the magnitude of the association between gestational duration and offspring mortality. The ARR, for Apgar <7 at 5 minutes (41+0 to 41+6 vs 40+0 to 40+6 weeks, regardless of BMI), was 1.36 (95% CI 1.27–1.45). The risk for low Apgar score at 41+0 weeks was 1.5% among all children regardless of maternal BMI. Among children to women with BMI ≥30, this magnitude of risk was found already at 39+3 weeks. Conclusions In primiparous women with obesity the risk of stillbirth or death before 45 postmenstrual weeks were increased throughout all full‐term gestational age categories, compared with women with overweight or normal BMI. Children to obese women had the same risk for Apgar scores <7 at 5 minutes compared with women overall at earlier gestational age. The results suggest that maternal BMI needs to be considered when discussing timing of elective induction in term healthy pregnancies of primiparous women.https://doi.org/10.1111/aogs.14465Apgar scorebody mass indexgestational durationobesityoverweightperinatal outcome |
| spellingShingle | Lina Lindegren Andrea Stuart Andreas Herbst Karin Källén Relation between perinatal outcome and gestational duration in term primiparous pregnancies stratified by body mass index Acta Obstetricia et Gynecologica Scandinavica Apgar score body mass index gestational duration obesity overweight perinatal outcome |
| title | Relation between perinatal outcome and gestational duration in term primiparous pregnancies stratified by body mass index |
| title_full | Relation between perinatal outcome and gestational duration in term primiparous pregnancies stratified by body mass index |
| title_fullStr | Relation between perinatal outcome and gestational duration in term primiparous pregnancies stratified by body mass index |
| title_full_unstemmed | Relation between perinatal outcome and gestational duration in term primiparous pregnancies stratified by body mass index |
| title_short | Relation between perinatal outcome and gestational duration in term primiparous pregnancies stratified by body mass index |
| title_sort | relation between perinatal outcome and gestational duration in term primiparous pregnancies stratified by body mass index |
| topic | Apgar score body mass index gestational duration obesity overweight perinatal outcome |
| url | https://doi.org/10.1111/aogs.14465 |
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