Association between obesity in women with multiple gestations and adverse obstetric outcomes: a study of an American population database with over 136,000 unique deliveries

Abstract

Purpose

The purpose of this study is to compare obese and non-obese women with multiple pregnancies to determine the effects on pregnancy, delivery, and neonatal outcomes.

Methods

We conducted a retrospective population-based study utilizing data collected between 2004 and 2014 inclusively, from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A total of 137,303 multiple pregnancies were analyzed; 130,542 (95%) were non-obese, while 6761 (5%) were obese. An initial analysis was performed to identify the prevalence of obesity in women with multiple pregnancies. Subsequently, chi-square tests and binary logistic regression analyses were conducted to assess the association between obesity and multiple gestation in the context of obstetric complications.

Results

There was a statistically significant increase in the prevalence of obesity for women with multiple gestations (p < 0.0001). The obese group was at higher risk of pregnancy-induced hypertension (adjusted odd’s ratio [aOR] = 1.89, 95% confidence interval [CI] = 1.77–2.02), gestational hypertension (aOR = 1.84, CI = 1.65–2.05), preeclampsia (aOR = 1.68, CI = 1.55–1.81), preeclampsia or eclampsia superimposed on pre-existing hypertension (aOR = 1.86, CI = 1.58–2.20), gestational diabetes mellitus (aOR = 2.65, CI = 2.44–2.87), and placenta previa (aOR = 0.57, CI = 0.39–0.85). They were more likely to have preterm premature rupture of membranes (aOR = 1.19, CI = 1.06–1.34), chorioamnionitis (aOR = 1.24, CI = 1.03–1.51), caesarean deliveries (aOR = 1.28, CI = 1.18–1.38), wound complications (aOR = 1.65, CI = 1.31–2.08), and transfusions (aOR = 0.77, CI = 0.67–0.89). They were less likely to have small for gestational age neonates (aOR = 0.88, CI = 0.79–0.97), though more likely to have neonates with congenital anomalies (aOR = 1.56, CI = 1.16–2.10).

Conclusion

Obesity and multiple gestations are independent risk factors for adverse obstetric outcomes. Combined, when analyzed in a large population, obesity in multiple gestation increases the risk of maternal, delivery, and neonatal complications.