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Term Elective Induction of Labor and Pregnancy Outcomes Among Obese Women and Their Offspring

Gibbs Pickens, Cassandra M. PhD, MPH; Kramer, Michael R. PhD, MMSc; Howards, Penelope P. PhD, MS; Badell, Martina L. MD; Caughey, Aaron B. MD, PhD; Hogue, Carol J. PhD, MPH

doi: 10.1097/AOG.0000000000002408
Contents: Original Research

OBJECTIVE: To evaluate whether elective induction of labor between 39 through 41 weeks of gestation, as compared with expectant management, is associated with reduced cesarean delivery and other adverse outcomes among obese women and their offspring.

METHODS: We conducted a retrospective cohort study using the 2007–2011 California Linked Patient Discharge Data–Birth Cohort File of 165,975 singleton, cephalic, nonanomalous deliveries to obese women. For each gestational week (39–41), we used multivariable logistic regression models, stratified by parity, to assess whether elective induction of labor or expectant management was associated with lower odds of cesarean delivery and other adverse outcomes.

RESULTS: At 39 and 40 weeks of gestation, cesarean delivery was less common in obese nulliparous women who were electively induced compared with those who were expectantly managed (at 39 weeks of gestation, frequencies were 35.9% vs 41.0%, respectively [P<.05]; adjusted odds ratio [OR] 0.82, 95% CI 0.77–0.88). Severe maternal morbidity was less frequent among electively induced obese nulliparous patients (at 39 weeks of gestation, 5.6% vs 7.6% [P<.05]; adjusted OR 0.75, 95% CI 0.65–0.87). Neonatal intensive care unit admission was less common among electively induced obese nulliparous women (at 39 weeks of gestation, 7.9% vs 10.1% [P<.05]; adjusted OR 0.79, 95% CI 0.70–0.89). Patterns were similar among obese parous women at 39 weeks of gestation (crude frequencies and adjusted ORs [95% CIs] were as follows: for cesarean delivery, 7.0% vs 8.7% [P<.05] and 0.79 [0.73–0.86]; for severe maternal morbidity, 3.3% vs 4.0% [P<.05] and 0.83 [0.74–0.94]; for neonatal intensive care unit admission: 5.3% vs 7.4% [P<.05] and 0.75 [0.68–0.82]). Similarly, elective induction at 40 weeks of gestation was associated with reduced odds of cesarean delivery, maternal morbidity, and neonatal intensive care unit admission among both obese nulliparous and parous patients.

CONCLUSION: Elective labor induction after 39 weeks of gestation was associated with reduced maternal and neonatal morbidity among obese women. Further prospective investigation is necessary.

In obese women, elective labor induction between 39 0/7 and 40 6/7 weeks of gestation was associated with reduced maternal and neonatal morbidity.

Department of Epidemiology, Rollins School of Public Health, and Laney Graduate School and the Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, School of Medicine, Emory University, Atlanta, Georgia; and the Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon.

Corresponding author: Cassandra M. Gibbs Pickens, PhD, MPH, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322; email:

Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (Grant 5T32HD052460-10, Emory University), Maternal and Child Health Bureau, Health Resources and Services Administration (Grant T03MC07651, Emory University), and Emory University Laney Graduate School. The funders had no role in study design; in data collection, analysis, or interpretation; in the writing of the manuscript; or in the decision to submit the article for publication.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the 29th Annual Meeting of the Society for Pediatric and Perinatal Epidemiologic Research, June 20–21, 2016, Miami, Florida.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.