Research

Pregnancy outcomes in super-obese women – an even bigger problem? A prospective cohort study

Marina Nieuwoudt, Johannes L van der Merwe, Justin Harvey, David R Hall

Abstract


Objective. To investigate whether differences exist in adverse pregnancy outcomes between morbidly obese (body mass index (BMI, kg/m2) 40 - 49.9) and super-obese women (BMI ≥50).

Methods: A prospective cohort study was undertaken at Tygerberg Hospital, a referral centre in the Western Cape Province of South Africa, of morbidly obese and super-obese pregnant women recruited from the antenatal clinic. Data were collected from the files 6 weeks after delivery. Primary outcomes included hypertension, diabetes mellitus and fetal macrosomia. Secondary outcomes included baseline characteristics, previous complications, antenatal and peripartum complications, and short-term neonatal outcomes.

Results. Sixty-six morbidly obese and 46 super-obese women were enrolled. Super-obese women experienced significantly higher incidences of pre-eclampsia (24% v. 9%; p=0.03) and interuterine growth restriction (13% v. 2%; p=0.02) than morbidly obese women, and both groups had a high incidence of gestational diabetes (24% v. 24%; non-significant (NS)). Both super-obese and morbidly obese women experienced high rates of caesarean section (54% v. 41%; NS). In super-obese women these procedures lasted longer (50 v. 41 minutes; p<0.01) and there were more surgical complications (36% v. 7%; p=0.01). Prolonged admission (>3 days) after delivery was also more common in super-obese women (65% v. 42%; p=0.03).

Conclusion. Super-obese women encounter more major pregnancy complications (especially hypertensive, pre-eclamptic and surgical) than morbidly obese women, emphasising the fact that these women should be managed at institutions with sufficient expertise.


Authors' affiliations

Marina Nieuwoudt, Department of Obstetrics and Gynaecology, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa

Johannes L van der Merwe, Department of Obstetrics and Gynaecology, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa

Justin Harvey, Centre of Statistical Consultation, Stellenbosch University, Tygerberg, Cape Town, South Africa

David R Hall, Department of Obstetrics and Gynaecology, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa

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Keywords

Pregnancy; Obesity; Super-obesity; Pre-eclampsia; Diabetes mellitus; Macrosomia

Cite this article

South African Journal of Obstetrics and Gynaecology 2014;20(2):54-59. DOI:10.7196/sajog.820

Article History

Date submitted: 2013-12-03
Date published: 2014-08-13

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