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Maternal Obesity: Significance on the Preterm Neonate

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Maternal Obesity: Significance on the Preterm Neonate International Journal of Obesity (2015) 39, 1433–1436 © 2015 Macmillan Publishers Limited All rights reserved 0307-0565/15 www.nature.com/ijo PEDIATRIC ORIGINAL ARTICLE Maternal obesity: significance on the preterm neonate R Khalak1, J Cummings1 and S Dexter2 BACKGROUND: What is known of neonatal outcomes associated with maternal obesity is limited. The impact on the preterm neonate, delivery room (DR) course and need for neonatal intensive care unit (NICU) admission has not been well established. METHODS: A review was done of our 17 county perinatal regions from the New York State Perinatal Data System database over the 3-year period of 1 January 2010–31 December 2012 for mother/baby dyad information for all live births 34–36 6/7 weeks’ gestation. The National Institutes of Health body mass index (BMI) classification was used for maternal BMI with the category definitions of underweight, normal, overweight, obese Level I, obese Level II, and obese Level III. RESULTS: Information was obtained on 2155 women. In this group, 29% had obese BMIs. The incidence of pre-pregnancy diabetes mellitus (DM), DM during gestation and cesarean delivery (CD) in obese mothers was significantly different from normal weight mothers, Po0.001. More infants of Level III mothers required DR resuscitation when compared with infants of normal BMI mothers, 36 vs 16%, P o0.001. The need for assisted ventilation beyond 6 h of age and need for NICU admission was more likely in infants of Level III mothers, Po0.001. Women in all of the obese subgroups had preterm infants with increased birth weights (BWs) compared with preterm infants of normal weight mothers, Po0.001. DISCUSSION: Late preterm infants born to obese mothers are more likely to be delivered by cesarean section and have larger BWs. We found that infants born to obese Level III mothers are much more likely to require assisted ventilation in the DR and NICU admission. International Journal of Obesity (2015) 39, 1433–1436; doi:10.1038/ijo.2015.107 INTRODUCTION preterm delivery imparted by maternal obesity. Cnattingius and Obesity has become a pervasive problem regardless of age, his group found that there was a dose–response relationship gender or socioeconomic background. One-third of adult females between worsening obesity and spontaneous extremely preterm in the United States meet the definition of obese as defined by a delivery. Although not as profound, there was almost a 1.5 times body mass index (BMI) of greater than 30 kg m− 2.1 Rates of obesity increased risk of spontaneous early delivery in the late preterm have increased over the past 10 years in pregnant women.2 More (32–36weeks gestation) group. women are obese at their first prenatal visit and then The objective for our study was to evaluate whether there subsequently gain more weight throughout the pregnancy than are increased complications in the preterm infant born to an ever before.3 Maternal obesity can lead to problems not only in obese mother, in addition to the risk imparted by late fi – the mother but also in the neonate as well. A research group in prematurity (de ned as 34 36 6/7 weeks gestation) or CD. The China found that a high pre-pregnancy BMI and excessive primary outcome for this study was the rate of NICU admission gestational weight to be associated with macrosomia.4 Studies and the need for DR resuscitation in late preterm neonates of obese parturients compared with normal BMI mothers. Minsart have shown that pregnant women with co-morbidities who are 13 also obese have a higher risk of worsening of their underlying et al. recently found increased NICU admission rates in infants disease during pregnancy.5,6 In 2009, Joy et al7 found that 29% of born to obese mothers. Similar to previous investigators, the women in their study had an obese BMI (⩾30) before becoming authors evaluated only term infants. We studied the late pregnant. Maternal morbidities associated with obesity included preterm infant group with the rationale that they are not gestational hypertension, gestational diabetes mellitus (DM), usually admitted to the NICU but they are at a higher risk assisted vaginal delivery and cesarean delivery (CD).8,9 An compared with term gestation infants for requiring resuscitation extensive mother–child cohort study done by investigators Heude assistance in the DR. Furthermore, a high percentage of the late et al found that women with higher gestational weight gain were preterm infants are often delivered at community hospitals with at a significantly increased risk for large for gestational age infants. limited resources. Interestingly, this association was only noted when controlled for 10 gestational DM and maternal hypertension. Term infants of MATERIALS AND METHODS obese mothers are more likely to be large for gestational age and require a higher level of nursery care.11 Nonetheless, the impact of Information was collected from the New York State Perinatal Data System (SPDS), a database of mothers and newborns that all New York State maternal obesity on neonatal outcome, the need for delivery hospitals are mandated to send reports. We reviewed data from mother– room (DR) resuscitation and neonatal intensive care unit (NICU) baby dyads for all live singleton births of late preterm, 34–36 6/7 weeks admission, particularly for the premature neonate, has not been as gestation, delivering in the Northeastern New York (NENY) 18 hospital/17 well studied. A recent study12 evaluated the risk of spontaneous county perinatal regions of upstate New York over the 3-year period of 1Division of Neonatology, Department of Pediatrics, Albany Medical Center, Albany, NY, USA and 2Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, USA. Correspondence: Dr R Khalak, Division of Neonatology, Department of Pediatrics, Albany Medical Center, MC-101, 43 New Scotland Avenue, Albany, NY 12208, USA. E-mail: [email protected] Received 14 January 2015; revised 17 April 2015; accepted 31 May 2015; accepted article preview online 8 June 2015; advance online publication, 30 June 2015 Maternal obesity and preterm neonate R Khalak et al 1434 1 January 2010 to 31 December 12. A perinatal transfer and affiliation RESULTS agreement exists between Albany Medical Center (the regional perinatal Data were analyzed from 2155 singleton late preterm deliveries. center) and the 17 other hospitals in the NENY region. The agreement Twenty-nine percent of these women were classified as obese incorporates data collection and evaluation of each hospital by utilizing (Level I–III, BMI 430 kg m−2). Infants born to overweight or obese the statewide perinatal data system SDPS. Before receiving this fi mothers were significantly more likely to have higher birth BW, de-identi ed information, study approval was obtained from the Albany 4 −2 Medical Center Investigational Review Board. For the purposes of this Table 1. Infants born by CD to Level III (BMI 40 kg m ) obese study, pre-pregnancy BMI was used for categorization following National women were more than twice as likely to need DR resuscitation, Institute of Health BMI classification: underweight (BMI o18.5), normal 36 vs 16% when compared with infants born to normal BMI − (BMI 18.5–24.9), overweight (BMI 25–29.9), obese Level I (BMI 30–34.9), (18.5–24.9 kg m 2) mothers delivered by CD. Although infants obese Level II, or severely obese (BMI 35–39.9), and obese Level III or delivered vaginally to mothers in this highest BMI group did not morbidly obese (BMI ⩾ 40). Data collection recorded characteristics of the have an increased need for DR resuscitation, they were mother including parity, pre-pregnancy BMI, diabetes screening, smoking, significantly more likely to require NICU admission. In addition, alcohol use, co-morbidities (pre-eclampsia, infections and congenital infants of Level III obese mothers required respiratory support anomalies), and demographics (age, race and marital status). Delivery beyond 6 h of age more often than infants of normal BMI mothers characteristics included prolonged premature rupture of membranes, maternal fever, group B streptococcus carrier status, operative vaginal regardless of the route of delivery, Table 1. delivery, and cesarean section. Infant data that were collected included As shown in Table 2 with the breakdown of the number of fi gestational age, birth weight (BW), gender, Apgar scores, need for and women in each category, obese women were signi cantly more degree of resuscitation in DR (for example, positive pressure ventilation, likely to have co-morbidities during pregnancy of pre-pregnancy endotracheal tube and chest compressions), NICU admission and need for DM, gestational DM and CD when compared to mothers with respiratory support outside the DR. The Institute of Medicine weight gain normal BMI. Comparisons of normal BMI mothers with overweight recommendations for pregnancy were used as published by the American (non-obese) BMI women also showed a difference for gestational 14 College of Obstetricians and Gynecologists, ACOG. These guidelines state DM and CD. Women who were underweight were much more −2 that with a BMI of o18.5 kg m , an acceptable range for weight gain is likely to be smokers, 49 vs 29%. Morbidly obese (Level III) women 28–40 pounds (lbs), a BMI of 18.5–24.9, acceptable range of 25–35 lbs, BMI – – in our study were also more likely to be non-white. of 25 29.9, acceptable range of 15 25 lbs, and women of all obese classes Table 3 shows the impact of pregnancy weight gain on infant should only gain 11–20 lbs. Demographic characteristics as well as maternal and neonatal diagnoses BW. Gestational weight gain was expressed as either normal or were compared for mothers and infants after division into the six BMI excessive weight gain as per the ACOG guidelines.
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