Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study

Elizabeth A Sullivan^{1

2}, Jan E Dickinson³, Geraldine A Vaughan⁴, Michael J Peek^{5

6}, David Ellwood^{7

8}, Caroline S E Homer⁹, Marian Knight¹⁰, Claire McLintock¹¹, Alex Wang¹², Wendy Pollock^{13

14}, Lisa Jackson Pulver¹⁵, Zhuoyang Li¹⁶, Nasrin Javid¹⁷, Elizabeth Denney-Wilson¹⁸, Leonie Callaway^{19

20}; Australasian Maternity Outcomes Surveillance System

Affiliations

¹ Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. elizabeth.sullivan@uts.edu.au.
² School of Women's and Children's Health, The University of New South Wales, Sydney, Australia. elizabeth.sullivan@uts.edu.au.
³ School of Women's and Infants' Health, The University of Western Australia, Perth, Australia. Jan.Dickinson@uwa.edu.au.
⁴ Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. Geraldine.Vaughan@uts.edu.au.
⁵ Department of Obstetrics and Gynaecology Medical School College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia. michael.peek@sydney.edu.au.
⁶ Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Canberra, Australia. michael.peek@sydney.edu.au.
⁷ School of Medicine, Griffith University, Queensland, Australia. d.ellwood@griffith.edu.au.
⁸ Gold Coast University Hospital, Queensland, Australia. d.ellwood@griffith.edu.au.
⁹ Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. Caroline.Homer@uts.edu.au.
¹⁰ National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom. marian.knight@npeu.ox.ac.uk.
¹¹ Obstetrics and Gynaecology, National Women's Health, Auckland City Hospital, Auckland, New Zealand. CMcLintock@adhb.govt.nz.
¹² Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. Alex.wang@uts.edu.au.
¹³ Judith Lumley Centre, La Trobe University, Melbourne, Australia. W.Pollock@latrobe.edu.au.
¹⁴ Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia. W.Pollock@latrobe.edu.au.
¹⁵ Muru Marri Indigenous Health Unit, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia. lisa.jackson-pulver@unsw.edu.au.
¹⁶ Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. Zhuoyang.Li@uts.edu.au.
¹⁷ Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. Nasrin.Javid@uts.edu.au.
¹⁸ Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. Elizabeth.Denney-Wilson@uts.edu.au.
¹⁹ Royal Brisbane and Women's Hospital, Brisbane, Australia. l.callaway@uq.edu.au.
²⁰ School of Medicine, The University of Queensland, Brisbane, Australia. l.callaway@uq.edu.au.

PMID: 26628074
PMCID: PMC4667490
DOI: 10.1186/s12884-015-0693-y

Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study

Elizabeth A Sullivan et al. BMC Pregnancy Childbirth. 2015.

. 2015 Dec 2:15:322.

doi: 10.1186/s12884-015-0693-y.

Authors

Affiliations

¹ Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. elizabeth.sullivan@uts.edu.au.
² School of Women's and Children's Health, The University of New South Wales, Sydney, Australia. elizabeth.sullivan@uts.edu.au.
³ School of Women's and Infants' Health, The University of Western Australia, Perth, Australia. Jan.Dickinson@uwa.edu.au.
⁴ Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. Geraldine.Vaughan@uts.edu.au.
⁵ Department of Obstetrics and Gynaecology Medical School College of Medicine, Biology and Environment, The Australian National University, Canberra, Australia. michael.peek@sydney.edu.au.
⁶ Obstetrics and Gynaecology, Centenary Hospital for Women and Children, Canberra, Australia. michael.peek@sydney.edu.au.
⁷ School of Medicine, Griffith University, Queensland, Australia. d.ellwood@griffith.edu.au.
⁸ Gold Coast University Hospital, Queensland, Australia. d.ellwood@griffith.edu.au.
⁹ Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. Caroline.Homer@uts.edu.au.
¹⁰ National Perinatal Epidemiology Unit, University of Oxford, Oxford, United Kingdom. marian.knight@npeu.ox.ac.uk.
¹¹ Obstetrics and Gynaecology, National Women's Health, Auckland City Hospital, Auckland, New Zealand. CMcLintock@adhb.govt.nz.
¹² Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. Alex.wang@uts.edu.au.
¹³ Judith Lumley Centre, La Trobe University, Melbourne, Australia. W.Pollock@latrobe.edu.au.
¹⁴ Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia. W.Pollock@latrobe.edu.au.
¹⁵ Muru Marri Indigenous Health Unit, School of Public Health and Community Medicine, The University of New South Wales, Sydney, Australia. lisa.jackson-pulver@unsw.edu.au.
¹⁶ Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. Zhuoyang.Li@uts.edu.au.
¹⁷ Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. Nasrin.Javid@uts.edu.au.
¹⁸ Faculty of Health, University of Technology Sydney, PO Box 123, Broadway NSW, 2007, Sydney, Australia. Elizabeth.Denney-Wilson@uts.edu.au.
¹⁹ Royal Brisbane and Women's Hospital, Brisbane, Australia. l.callaway@uq.edu.au.
²⁰ School of Medicine, The University of Queensland, Brisbane, Australia. l.callaway@uq.edu.au.

PMID: 26628074
PMCID: PMC4667490
DOI: 10.1186/s12884-015-0693-y

Abstract

Background: Super-obesity is associated with significantly elevated rates of obstetric complications, adverse perinatal outcomes and interventions. The purpose of this study was to determine the prevalence, risk factors, management and perinatal outcomes of super-obese women giving birth in Australia.

Methods: A national population-based cohort study. Super-obese pregnant women (body mass index (BMI) >50 kg/m(2) or weight >140 kg) who gave birth between January 1 and October 31, 2010 and a comparison cohort were identified using the Australasian Maternity Outcomes Surveillance System (AMOSS). Outcomes included maternal and perinatal morbidity and mortality. Prevalence estimates calculated with 95% confidence intervals (CIs). Adjusted odds ratios (ORs) were calculated using multivariable logistic regression.

Results: 370 super-obese women with a median BMI of 52.8 kg/m(2) (range 40.9-79.9 kg/m(2)) and prevalence of 2.1 per 1 000 women giving birth (95% CI: 1.96-2.40). Super-obese women were significantly more likely to be public patients (96.2%), smoke (23.8%) and be socio-economically disadvantaged (36.2%). Compared with other women, super-obese women had a significantly higher risk for obstetric (adjusted odds ratio (AOR) 2.42, 95% CI: 1.77-3.29) and medical (AOR: 2.89, 95% CI: 2.64-4.11) complications during pregnancy, birth by caesarean section (51.6%) and admission to special care (HDU/ICU) (6.2%). The 372 babies born to 365 super-obese women with outcomes known had significantly higher rates of birthweight ≥ 4500 g (AOR 19.94, 95 % CI: 6.81-58.36), hospital transfer (AOR 3.81, 95 % CI: 1.93-7.55) and admission to Neonatal Intensive Care Unit (NICU) (AOR 1.83, 95% CI: 1.27-2.65) compared to babies of the comparison group, but not prematurity (10.5% versus 9.2%) or perinatal mortality (11.0 (95% CI: 4.3-28.0) versus 6.6 (95% CI: 2.6- 16.8) per 1 000 singleton births).

Conclusions: Super-obesity in pregnancy in Australia is associated with increased rates of pregnancy and birth complications, and with social disadvantage. There is an urgent need to further address risk factors leading to super-obesity among pregnant women and for maternity services to better address pre-pregnancy and pregnancy care to reduce associated inequalities in perinatal outcomes.

PubMed Disclaimer

Figures

**Fig. 1**
Surveillance and confirmed cases of super-obese women who gave birth in Australia, 2010

**Fig. 2**
Distribution of body mass index of super-obese and comparison women who gave birth in Australia, 2010

See this image and copyright information in PMC

References

1. OECD. Health at a Glance 2013: OECD Indicators. Edited by EOECD. Paris, France: OECD Publishing; 2013.
1. Hilder L, Zhichao Z, Parker M, Jahan S, Chambers G. Australia’s mothers and babies 2012. In: AIHW, editor. Perinatal statistics series no 30. Canberra: AIHW; 2014.
1. Mason EE, Doherty C, Maher JW, Scott DH, Rodriguez EM, Blommers TJ. Super obesity and gastric reduction procedures. Gastroenterol Clin N Am. 1987;16(3):495–502. - PubMed
1. Marshall NE, Guild C, Cheng YW, Caughey AB, Halloran DR. Maternal superobesity and perinatal outcomes. Am J Obstet Gynecol. 2012;206(5):417. - PMC - PubMed
1. Alanis MC, Goodnight WH, Hill EG, Robinson CJ, Villers MS, Johnson DD. Maternal super-obesity (body mass index > or = 50) and adverse pregnancy outcomes. Acta Obstet Gynecol Scand. 2010;89(7):924–30. doi: 10.3109/00016341003657884. - DOI - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

NIHR-RP-011-032/DH_/Department of Health/United Kingdom

LinkOut - more resources

Full Text Sources
Other Literature Sources
- scite Smart Citations
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study

Affiliations

Maternal super-obesity and perinatal outcomes in Australia: a national population-based cohort study

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical