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Is maternal prepregnancy BMI associated with duration of active labor?

Is maternal prepregnancy BMI associated with duration of active labor?. PH251A Date Author Author Author. Hypothesis.

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Is maternal prepregnancy BMI associated with duration of active labor?

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  1. Is maternal prepregnancy BMI associated with duration of active labor? PH251A Date Author Author Author

  2. Hypothesis • Higher maternal prepregnancy BMI is associated with a longer duration of active labor among nulliparous women in the Child Health and Development Studies (CHDS) data set. • Active Labor: 3-10cm dilation of cervix.

  3. Biological Plausibility • During pregnancy, maternal fat accumulates centrally particularly among obese women.1,2 • Deposits narrow the diameter of birth canal leading to prolonged labor.3 • Soft tissue deposits + larger fetus  longer duration.4 1Soltani H, Fraser RB. Br J Nutr. 2000. 2Ehrenberg HM, Huston-Presley L, Catalano PM. Am J Obstet Gynecol. 2003. 3Vahratian A, Zhang J, Troendle JF, et al. Obstet Gynecol. 2004. 4Jensen H, Agger AO, Rasmussen KL.ActaObstetGynecol Scand. 1999.

  4. Public Health Concerns • Current rates of overweight and obese women of childbearing age is increasing.1 • Obesity prevalence among US women ≥20yrs: 35.5% (1999-2008).4 • Longer duration of labor is associated with adverse maternal and neonatal outcomes.2,3 1Cogswell ME, Perry GS, Schieve LA, Dietz WH. Prim Care Update Ob Gyns2001. 2Rouse DJ, Weiner SJ, Bloom SL, et al. ObstetGynecol2009. 3Allen VM, Baskett TF, O’Connell CM, et al. Obstet Gynecol. 2009. 4Flegal KM et al. JAMA. 2010.

  5. Literature Review • Median duration of labor from 3-10cm significantly longer for both overweight and obese women.3 • Median time to delivery longer across BMI; not a consistent finding.1,2 • Duration of labor positively correlated with gestational weight gain and prepregnancy weight.4 1Pevzner L, Powers BL, Rayburn WF et al. ObstetGynecol 2009. 2Sarkar RK, Cooley SM, Donnelly JC, et al. The Journal of Maternal-Fetal and Neonatal Medicine. 2007. 3Vahratian A, Zhang J, Troendle JF, et al. Obstet Gynecol. 2004. 4Nesheim, BI., ActaObstetGynecol Scand. 1988..

  6. Methods • Child Health and Development Studies (CHDS), 1959-1967 • Secondary data analysis • Univariate • Bivariate • Multivariate regression • Check for interaction

  7. Independent Variable • 3-part maternal prepregnancy BMI (kg/m2) • Underweight: <18.5 • Normal: 18.5-24.9 • Overweight/Obese: ≥25

  8. Dependent Variable • Length of Active Labor (hrs) • Continuous • 2-part: ≤12 hours and >12 hours1 1Neal, JL, et al., JOGNN. 2010.

  9. Covariates • Maternal age • Maternal race • Infant sex • Type of anesthetic • SES • Birthweight • Gestational weight gain • Oxytocin stimulation • Total drug doses

  10. Covariates • Maternal age • Maternal race • Infant sex • Type of anesthetic • SES • Birthweight • Gestational weight gain • Oxytocin stimulation • Total drug doses

  11. Covariates • Maternal age • Maternal race • Infant sex • Type of anesthetic • SES • Birthweight • Gestational weight gain • Oxytocin stimulation • Total drug doses

  12. Covariates • Maternal age • Maternal race • Infant sex • Type of anesthetic • SES • Birthweight • Gestational weight gain • Oxytocin stimulation • Total drug doses

  13. Univariate Results

  14. Women with BMI ≥25 are more likely to be in the lowest two wealth quintiles.

  15. Women in the middle and lowest wealth quintiles have longer labor times.

  16. As BMI increases, percent of LBW decreases.

  17. Women with normal weight babies are more likely to have longer labor times.

  18. Women with BMI ≥25 are more likely to gain more than recommended.

  19. Gaining more than recommended is associated with longer labor time.

  20. Women with BMI ≥25 are more likely to receive oxytocin stimulation.

  21. Women who receive oxytocin are more likely to have a longer labor.

  22. Women with BMI ≥25 are more likely to receive general anesthesia.

  23. Women who receive regional anesthesia have longer labor times.

  24. Crude Association: Bivariate Outcome There is a slight trend: increased BMI associated with higher prevalence of >12 hour labor.

  25. Crude Association: Continuous Outcome

  26. Multivariate Model • Final Model Includes: • BMI • Age • Race • Class • Birthweight (low/normal) • Gestational weight gain • Oxytocin stimulation • Total drug doses • Anesthetic type

  27. Odds of >12 hour labor time: *There was no interaction between maternal BMI and gestational weight gain.

  28. Odds of >12 hour labor time:

  29. In summary… • No significant association between maternal prepregnancy BMI and the duration of active labor. • Gestational weight gain is significantly associated with duration of active labor. • 2.5 the odds of labor >12 hours • Women with higher BMI: • Receive more doses • Are more likely to receive oxytocin

  30. Discussion: Strengths • Large sample: N=3,012 • Covariate availability • Cesareans

  31. Discussion: Limitations • BMI distribution • Drugs • Anesthetics • Homogenous • Restricted sample

  32. Thank you!

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