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Neonatal Morbidity in the Offspring of Obese Women Without Hypertension or Diabetes

Polnaszek, Brock E., MD; Raghuraman, Nandini, MD, MS; Lopez, Julia D., PhD, MPH; Frolova, Antonina L., MD; Wesevich, Victoria, BS; Tuuli, Methodius G., MD, MPH; Cahill, Alison G., MD, MSCI

doi: 10.1097/AOG.0000000000002775
Contents: Obesity: Original Research

OBJECTIVE: To compare the independent risk of neonatal morbidity between the offspring of obese and nonobese women without hypertension or diabetes.

METHODS: This is a secondary analysis of a prospective single-center cohort study of singleton deliveries at or beyond 37 weeks of gestation from 2010 to 2014. Women with diabetes (pregestational or gestational) and hypertensive disorders were excluded. The primary outcomes were 1) a composite neonatal morbidity including death, mechanical ventilation, respiratory distress, meconium aspiration, suspected sepsis, confirmed sepsis, hypoxic–ischemic encephalopathy, therapeutic hypothermia, or seizures; and 2) a composite of neonatal neurologic morbidity including hypoxic–ischemic encephalopathy, therapeutic hypothermia, or seizures. The primary outcomes were compared between the offspring of obese (body mass index 30 or greater) and nonobese women. Adjusted odds ratios (ORs) were estimated using multivariable logistic regression.

RESULTS: Of 6,458 women without diabetes or hypertensive disorders, 3,311 (51%) were obese. After adjusting for race, neonates of obese patients were at significantly increased risk for the composite neonatal morbidity (9.2% vs 7.2%, adjusted OR 1.39, 95% CI 1.15–1.67) and neurologic neonatal morbidity (0.7% vs 0.3%, adjusted OR 2.84, 95% CI 1.22–6.65). Specifically, neonates of obese patients were more likely to have hypoxic–ischemic encephalopathy (0.5% vs 0.2%, adjusted OR 2.80, 95% CI 1.02–7.68), hypothermia treatment (0.6% vs 0.2%, adjusted OR 2.92 95% CI 1.17–7.30), and suspected sepsis (7.6% vs 5.8%, adjusted OR 1.45, 95% CI 1.18–1.79).

CONCLUSION: In patients who labor, maternal obesity is an independent risk factor for significant neonatal morbidity, even in the absence of hypertensive disorders or diabetes.

Even in the absence of maternal hypertension or diabetes, the offspring of obese women are at increased risk of neonatal morbidity compared with the offspring of nonobese women.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri.

Corresponding author: Brock E. Polnaszek, MD, Department of Obstetrics and Gynecology, Washington University in St Louis School of Medicine, 901 Forest Park Avenue, St Louis, MO 63108; email:

Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD061619-01, A.G.C., Principal Investigator). Dr. Cahill was a Robert Wood Johnson Foundation Faculty Physician Scholar, which partially supported this work. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health or the Robert Wood Johnson Foundation.

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

Presented at the Society for Maternal-Fetal Medicine’s Annual Meeting, January 29–February 3, 2018, Dallas, Texas.

The authors thank Tracy Burger for her help with the collection of data.

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.