The combined effect of pre-pregnancy body mass index and gestational weight gain on the risk of pre-labour and intrapartum caesarean section-The ICE-MCH study

• Published in: PloS one Vol. 18; no. 1; p. e0280060
• Main Authors: Eloranta, Aino-Maija, Gunnarsdottir, Ingibjörg, Thorisdottir, Birna, Gunnlaugsson, Geir, Birgisdottir, Bryndis Eva, Thorsdottir, Inga, Einarsdóttir, Kristjana
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 05.01.2023; Public Library of Science (PLoS)
• Subjects: Access to information; Biology and Life Sciences; Body mass; Body Mass Index; Body size; Body weight; Body weight gain; Causes of; Cesarean section; Cesarean Section - adverse effects; Child; Childbirth & labor; Childrens health; Codes; Complications and side effects; Confidence intervals; Diabetes; Female; Gestational age; Gestational Weight Gain; Health aspects; Health risks; Humans; Hypertension; Maternal & child health; Medicine and Health Sciences; Obesity; Obesity - complications; Overweight; Overweight - complications; Preeclampsia; Pregnancy; Pregnancy Complications - etiology; Pregnancy Outcome; Pregnant women; Premature labor; Primary care; Regression analysis; Regression models; Risk; Risk Factors; Statistical analysis; Underweight; Weight gain; Womens health; Finland; Iceland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0280060

Women who are obese before pregnancy have a higher risk of caesarean section than normal weight women. We investigated the combined effect of pre-pregnancy weight and gestational weight gain on pre-labour and intrapartum caesarean section risk. We collected data on 22,763 singleton, term, live deliveries in 2003-2014 from the Icelandic Maternal and Child Health Study (ICE-MCH), based on Icelandic registries. These were the Icelandic Medical Birth Registry and the Saga Maternal and Child Health Database. Pre-pregnancy body mass index was categorised into underweight, normal weight, overweight and obese. Gestational weight gain was classified according to the Institute of Medicine´s recommendation into below, within and above the recommended range. Logistic regression models, adjusted for maternal and gestational characteristics, were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the risk of caesarean section. Obese women had a higher risk of pre-labour (AOR 1.56, 95% CI 1.34-1.81) and intrapartum caesarean section (AOR 1.92, 95% CI 1.70-2.17) than normal weight women in all categories of gestational weight gain. Gestational weight gain above the recommended range, compared to within the range, increased the risk of intrapartum caesarean section among normal weight (AOR 1.46, 95% CI 1.23-1.73) and overweight women (AOR 1.291, 95% CI 1.04-1.60). Gestational weight gain below the recommended range, compared to within the range, increased the risk of pre-labour caesarean section (AOR 1.64, 95% CI 1.20-2.25), but only among overweight women. Women who are obese before pregnancy have a high risk of caesarean section regardless of gestational weight gain. However, women who are normal weight or overweight before pregnancy and gain weight above the recommended range during pregnancy may also have an increased risk of caesarean section.