Bariatric Obstetrics: The Demographics of Extreme Obesity
Abstract Number: 63
Abstract Type: Original Research
Introduction: Obesity is common at our university hospital; 55% of our parturients have a BMI > 30 kg/m2 and 17% have a BMI > 40 kg/m2. All published studies that correlate BMI with outcome combine patients with BMI > 40 kg/m2 into one group for comparison.(1,2) We hypothesized that medical, obstetric, anesthetic, and neonatal outcomes would differ by BMI within this group. Therefore, we performed this retrospective study to test this hypothesis.
Methods: With IRB approval, we are collecting demographic, medical, obstetric, neonatal, and anesthetic data on all patients who delivered at our hospital during 2008. Patients missing height or delivery weight data are excluded. Patients are combined into delivery BMI deciles (30-39, 40-49, etc.), except patients with the highest and lowest BMIs, who are combined into >60 and <29 groups, respectively. We record maternal age, height, pre-pregnancy and delivery weight, the incidence of pre-eclampsia, chronic and gestational hypertension, gestational and pre-pregnancy diabetes, asthma, tobacco use, substance abuse, neonatal weight, Apgar scores, umbilical blood gas values, and maternal and neonatal complications. Statistical analysis will be performed when data collection is completed.
Results: Information has been collected on 886 of an estimated 3500 parturients. BMIs range from 18 to 102 kg/m2. Patients with a BMI > 60 appear to have a higher incidence of pre-eclampsia, chronic hypertension, gestational diabetes, and asthma but a lower incidence of tobacco use and substance abuse. Cesarean and stat cesarean rates do not differ by BMI group. The incidence of co-morbidities among patients with a BMI between 40 and 60 does not differ from that in thinner parturients. (Table) All of the patients in the highest BMI group received epidural or CSE analgesia for labor (with difficulty and 5" epidural needles), none of the blocks failed, and 33% were successfully used for subsequent cesarean delivery.
Discussion: Increasingly heavy parturients now require obstetric anesthetic care. In contrast to previous reports, we are finding that the incidence of co-morbidities increases in patients with a BMI above 60 kg/m2 but not in patients with a BMI between 40 and 60 kg/m2.(1,2)
1. Chu SY. N Engl J Med 2008;358:1444-53.
2. Cedergren MI. Obstet Gynecol 2004;103:219-24.