Poster Session 2
Raina A. Meka, MD (she/her/hers)
Fellow
Washington University School of Medicine in St. Louis
St. Louis, MO, United States
Nandini Raghuraman, MD, MSCI
Assistant Professor of Ob&Gyn
Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States
.jpg "Alison G. Cahill, MD, MSCI photo")
Alison G. Cahill, MD, MSCI
Associate Dean of Translational Research,
Professor of Women's Health
The University of Texas at Austin
Austin, Texas, United States
Jeannie C. Kelly, MD, MS (she/her/hers)
Associate Professor
Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States
Katherine H. Bligard, MA, MD
Assistant Professor of Ob&Gyn
Washington University School of Medicine in St. Louis
St. Louis, Missouri, United States
Antonina I. Frolova, MD, PhD (she/her/hers)
Assistant Professor of Ob&Gyn
Washington University School of Medicine
St. Louis, Missouri, United States
Prepregnancy BMI (preBMI) represents baseline health status before pregnancy and is used to guide counseling and management to prevent adverse perinatal outcomes. However, preBMI is often unavailable or unreliable due to recollection bias. Delivery BMI (delBMI) encompasses the cumulative effects of preBMI and gestational weight gain (GWG). We sought to compare the ability of preBMI and delBMI to predict adverse maternal and neonatal outcomes.
Study Design:
This was a secondary analysis of a prospective cohort study of all individuals with a singleton gestation who presented for induction or spontaneous labor at ≥ 37 weeks’ gestation at a single institution from 2010-2014. Only individuals with a measured weight in the chart during the year prior to pregnancy were included in this analysis, allowing for accurate calculation of preBMI. Receiver operating characteristic (ROC) curves were used to compare the abilities of preBMI and delBMI to predict labor, maternal, and neonatal adverse outcomes.
Results:
Among 8,580 patients in the original cohort, 2,964 had a prepregnancy weight recorded and were included in this study. In isolation, delBMI and preBMI were poor predictors of adverse outcomes. However, delBMI was a better predictor than preBMI of labor outcomes including primary cesarean section (Figure 1), labor > 24 hours, prolonged second stage of labor, and shoulder dystocia (Table 1). DelBMI was also a better predictor of hypertensive disorders of pregnancy (HDP), while preBMI was a better predictor of gestational diabetes (GDM) (Table 1). There was no difference in the ability of delBMI and preBMI to predict neonatal outcomes, including composite adverse neonatal outcome, fetal acidemia, NICU admission, and neonatal hypoglycemia (Table 1).
Conclusion:
PreBMI and delBMI are individually poor predictors of adverse pregnancy outcomes. However, delBMI is a better predictor of adverse labor outcomes and HDP, while preBMI is a better predictor for GDM. Comprehensive risk assessment may need to reflect maternal weight throughout pregnancy, incorporating preBMI, delBMI and GWG as a dynamic measure.
