Pregnancy in obese patients: which risks is it necessary to fear?

Objective. - To evaluate the deleterious effects of maternal obesity on obstetrical complications and neonatal outcomes. Patients and methods. - Historical cohort study including all patients delivered in our maternity between 1(st) January 2002 and 31(st) December 2004. Intra uterine death and fetal loss before 22 weeks were excluded. Women were categorized by the Body Mass Index: less than 25, between 25 and 30, and more than 30. Maternal data, obstetrical complications, labor and its complications, and neonatal outcomes were studied. Results. - During these 3 years, 23.5% (1336/5686) of patients were overweight and 7.5% (425/5686) were obese: Obstetrical pathologies (gestational diabetes mellitus, hypertension, preeclampsia and fetal macrosomia) and labour induction were more significantly frequent in-obese patients (P < 0.01). We noted twice more caesarean sections during labour in obese patients. The rate of artificial placental delivery was significantly higher in obese patients (P < 0.01). Obese patients with prior caesarean sections had a rate of vaginal delivery significantly lower than non obese patients with prior C-sections (23.6 vs 43.8%; P <.0.01). Mean children birth weight was significantly higher in obese patients (3305 vs 3181 g; P < 0.01) with no impact on Apgar score. Discussion and conclusion. - Our study confirms that obesity is responsible or major obstetrical complications, for what should no doubt be considered as high risk pregnancies. Our practices must take these complications into account by ensuring an adapted and early management in order to improve maternal and neonatal issues. (C) 2006 Elsevier Masson SAS. Tous droits reserves.