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Maternal body mass index and duration of labor
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
Lund University, Sweden .
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Barn- och kvinnocentrum, Kvinnokliniken i Linköping.
2013 (Engelska)Ingår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 171, nr 1, s. 49-53Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To evaluate whether the duration of the active phase of labor is associated with maternal body mass index (BMI), in nulliparous women with spontaneous onset of labor. less thanbrgreater than less thanbrgreater thanStudy design: Historical prospective cohort study including 63,829 nulliparous women with a singleton pregnancy and a spontaneous onset of labor, who delivered between January 1, 1995 and December 31, 2009. Data were collected from the Perinatal Revision South registry, a regional perinatal database in Southern Sweden. Women were categorized into six classes of BMI. Overweight and obese women were compared to normal weight women regarding duration of active labor. Adjustments were made for year of delivery, maternal age and infant birth weight. less thanbrgreater than less thanbrgreater thanResults: The median duration of labor was significantly longer in obese women (class I obesity (BMI 30-34.9) = 9.1 h, class II obesity (BMI 35-39.9) = 9.2 h and class III obesity (BMI andgt; 40) = 9.8 h) compared to normal-weight women (BMI 18.5-24.9) = 8.8 h (p andlt; 0.001). The risk of labor lasting more than 12 h increased with increasing maternal BMI: OR 1.04(1.01-1.06) (OR per 5-units BMI-increase).The risk of labor lasting more than 12 h or emergency cesarean section within 12 h, compared to vaginal deliveries within 12 h, increased with increasing maternal BMI. Duration of the second stage of labor was significantly shorter in obese women: in class III obesity the median value was 0.45 h compared to normal weight women, 0.55 h (p andlt; 0.001). less thanbrgreater than less thanbrgreater thanConclusion: In nulliparous women with a spontaneous onset of labor, duration of the active phase of labor increased significantly with increasing maternal BMI. Once obese women reach the second stage they deliver more quickly than normal weight women, which implies that the risk of prolonged labor is restricted to the first stage of labor. It is clinically important to consider the prolonged first stage of labor in obese women, for example when diagnosing first stage labor arrest, in order to optimize management of this rapidly growing at-risk group of women. Thus, it might be reasonable to adapt the considered upper limit for duration of labor, according to maternal BMI.

Ort, förlag, år, upplaga, sidor
Elsevier , 2013. Vol. 171, nr 1, s. 49-53
Nyckelord [en]
Maternal body mass index, Obesity, Active phase of labor, Second stage of labor, Nulliparous women
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:liu:diva-102720DOI: 10.1016/j.ejogrb.2013.08.021ISI: 000327562900011OAI: oai:DiVA.org:liu-102720DiVA, id: diva2:681163
Tillgänglig från: 2013-12-19 Skapad: 2013-12-19 Senast uppdaterad: 2019-02-11
Ingår i avhandling
1. Maternal obesity, duration of labor and the role of leptin
Öppna denna publikation i ny flik eller fönster >>Maternal obesity, duration of labor and the role of leptin
2018 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: The prevalence of obesity substantially increases in pregnant women. Maternal obesity is associated with adverse maternal and neonatal outcomes. The increased risk for cesarean section present in obese women has been related to potential impaired uterine contractility. The mechanism that underlies this theory is not clear. In vitro studies have shown that leptin, produced by adipose tissue and the placenta, exerts an inhibitory effect on myometrial contractility. The aim of this thesis was to evaluate the labor process in relation to maternal body mass index (BMI) and the clinical role of leptin in this process.

Material and Methods: Studies I-IV are cohort studies. The first two studies analyze the association between labor duration and maternal BMI based on data from the Perinatal Revision South register and the Swedish Pregnancy Register. Study I included 63,829 nulliparous women with a spontaneous onset of labor between 1995 and 2009. Study II included 15,259 nulliparous women with induced labor between 2014 and 2017. In study III, the maternal leptin levels during and after pregnancy were analyzed in 343 obese women with respect to their obesity class (I-III) and degree of gestational weight gain (GWG). In study IV, the association between the maternal leptin levels measured in active labor and duration of the active phase of labor was analyzed in 914 women.

Results: The duration of spontaneous labor significantly increased with an increasing maternal BMI; however, the duration of the pushing phase was inversely related to BMI. Time in induced labor increased with maternal BMI; however, the differences between the BMI categories were more pronounced in the latent phase than the active phase. Leptin levels were higher in women with obesity class III than women with class I during and after pregnancy. The degree of GWG in obese women was not associated with maternal leptin. No significant association between maternal leptin and the duration of the active phase of labor was identified in the adjusted analyses.

Conclusions: Nulliparous obese women have a higher risk for a prolonged duration of spontaneous and induced labor. This is important to consider prior to diagnosing labor arrest that results in a cesarean delivery. As maternal leptin levels are increased with the degree of obesity during pregnancy, future research on the association of high maternal leptin levels and the duration of labor is warranted.

Ort, förlag, år, upplaga, sidor
Linköping: Linköping University Electronic Press, 2018. s. 56
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1626
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Identifikatorer
urn:nbn:se:liu:diva-147650 (URN)10.3384/diss.diva-147650 (DOI)9789176852804 (ISBN)
Disputation
2018-06-01, Berzeliussalen, Campus US, Linköping, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2018-05-03 Skapad: 2018-05-03 Senast uppdaterad: 2019-09-30Bibliografiskt granskad

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Blomberg, Marie

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Obstetrik och gynekologiHälsouniversitetetKvinnokliniken i Linköping
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European Journal of Obstetrics, Gynecology, and Reproductive Biology
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