Poster Session 4
Easha Patel, MD (she/her/hers)
Maternal Fetal Medicine Fellow
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Kirat Sandhu, MD
Resident
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Cara D. Dolin, MD, MPH
Assistant Professor of Obstetrics and Gynecology
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Stacey Ehrenberg, MD (she/her/hers)
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Maeve Hopkins, MD
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Adina R. Kern-Goldberger, MD, MPH, MSCE
Assistant Professor
Cleveland Clinic Lerner College of Medicine
Cleveland, Ohio, United States
Maternal obesity is a known risk factor for adverse maternal and perinatal outcomes. This study evaluates risk for these pregnancy complications among patients with class 3 obesity undergoing induction of labor (IOL).
Study Design:
This is a retrospective cohort study of nulliparous, singleton deliveries with BMI > 40 following induction of labor > 20 weeks at a multi-hospital academic health system from 1/1/2022-6/30/2024. The primary outcome was unplanned cesarean and secondary outcomes included severe maternal morbidity (SMM) without transfusion, postpartum hemorrhage, postpartum infection, postpartum length of stay > 5 days, maternal readmission, and NICU admission. Maternal clinical characteristics and outcomes were extracted from the medical record and compared in univariable analyses. The association between class 3 obesity and primary and secondary outcomes was evaluated using a logistic regression model based on significance from univariable analyses.
Results:
6,533 nulliparous patients undergoing IOL were included, 3.4% of whom had class 3 obesity. Numerous comorbidities and outcomes were different based on class 3 obesity status, including significantly higher rates of pregestational and gestational diabetes and chronic and gestational hypertension, but not severe preeclampsia (Table 1). Unadjusted incidence of NICU admission was twofold higher for patients with class 3 obesity (16.8 v. 8.4%, p < 0.01). Adjusted analysis demonstrated significantly increased odds of cesarean in nulliparous patients undergoing IOL with class 3 obesity compared to those without (aOR 1.97, 95% CI 1.51 – 2.56, p < 0.01), but for none of the secondary outcomes other than hemorrhage, which had significantly lower odds in class 3 obesity (Table 2).
Conclusion:
Nulliparous patients with class 3 obesity undergoing IOL have significantly higher risk of cesarean than those with lower BMI, but not for other adverse outcomes. Further study of predictors of successful vaginal delivery for patients with class 3 obesity is important.
