Does overweight and obesity have an impact on delivery mode and peripartum outcome in breech presentation? A FRABAT cohort study

Abstract

Purpose: Obesity is a worldwide and growing issue affecting women in childbearing age, complicating surgical procedures as well as pregnancy. Through a reduction of not necessarily required cesarean deliveries-for instance in pregnancies with breech presentation-obesity mediated and surgery-associated morbidity might be contained. Date on the impact of maternal BMI in vaginally attempted breech delivery is not existing. To give insight into whether an elevated BMI leads to an increased perinatal morbidity in vaginally intended deliveries out of breech presentation, we analyzed delivery outcome of laboring women with a singleton baby in breech presentation with overweight and obesity (BMI ≥ 25 kg/m²) in comparison to women with a BMI of below 25 kg/m².

Methods: Based on data from January 2004 to December 2020, a cohort study was performed on 1641 women presenting with breech presentation at term (> 37 weeks). The influence of maternal BMI on perinatal outcome was analyzed with Chi² testing for group differences and logistic regression analysis. Patients with a hyperglycemic metabolism were excluded from the study.

Results: Fetal morbidity was not different when patients with a BMI of ≥ 25 kg/m² (PREMODA morbidity score 2.16%) were compared to patients with a BMI of below 25 kg/m² (1.97%, p = 0.821). Cesarean delivery rates were significantly higher in overweight and obese women with 43.9% compared to 29.3% (p < 0.0001). BMI and cesarean delivery were significantly associated in a logistic regression analysis (Chi² coefficient 18.05, p < 0.0001). In successful vaginal deliveries out of breech presentation, maternal perineal injury rates (vaginal birth in normal-BMI women 48.4%; vaginal birth in overweight and obese women: 44.2%; p = 0.273) and rates of manually assisted delivery (vaginal birth in normal-BMI women: 44.4%; vaginal birth in obese and overweight women: 44.2%; p = 0.958) were not different between BMI groups.

Conclusions: Obesity and overweight are not associated with peripartum maternal or newborn morbidity in vaginally attempted breech delivery, if the patient cohort is thoroughly selected and vaginal breech delivery is in an upright maternal position. Reduction of cesarean delivery rates, especially in overweight and obese women might, have an important positive impact on maternal and newborn morbidity.

Keywords: Breech delivery; Maternal BMI; Obesity; Perinatal outcome.

Fig. 1

Flowchart displaying the study cohort with delivery outcome

Fig. 2

Logistic regression analysis BMI vs. cesarean section rate. Logistic regression analysis was performed plotting the cesarean section rates on the continuous variable BMI (kg/m²), displayed in A with each dot representing one patient. R²(U) = 0.0087 Chi² 18.05, p < 0.0001, Odds ratio per unit: 1.058 B) Reverse prediction calculation of the BMI with a Cesarean delivery rate of 30%: 21.15 kg/m² (95% CI 18.2–22.9 kg/m²) and 50%: 35.63 kg/m² (95% CI 31.5–45.9 kg/m²)