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The association between maternal size and outcomes for women undergoing for cesarean section: a multicentre prospective observational study (The MUM SIZE Study)
Abstract Number: F-35
Abstract Type: Original Research
Introduction:Obesity is defined by World Health Organization(WHO) as a body mass index(BMI) of ≥30 kg.m-2. Obesity in childbearing age women is increasing. This is thought to contribute to adverse pregnancy outcomes. During pregnancy, however, BMI may naturally increase leading to incorrect classification of term women according to WHO BMI categories & a reluctance of clinicians & researchers to use WHO BMI categories at term. Also, the rate of cesarean section (CS) is increasing which, when combined with larger BMI, may lead to adverse maternal & neonatal events, increased theatre times & increased hospital costs. There is little research in this area. We aimed to investigate associations between maternal size (using term pregnancy specific BMI cut-off values which were 5 kg.m-2 higher in each WHO category), & clinical, theatre utilization & health economic outcomes for women having CS.
Method:Following IRB approval, consent & trial registration (ACTRN1261300060876) we undertook a prospective multicentre observational study in women undergoing CS. We recorded BMI at initial antenatal (booking) visit & delivery. Linear regression models accounting for clustering within hospitals & confounders, & health economic models analysed associations between delivery BMI & total theatre time, surgical & anesthesia times, maternal & neonatal adverse outcomes, total hospital costs, & theatre costs.
Results:1457 women from 7 hospitals were included. Mean gestation was 38 weeks. Mean BMI increase (booking to delivery) was 4.0 kg.m-2. For each unit BMI increase total theatre time increased by 0.6 min(minutes)(p<0.001)(Figure 1). Super-obese (BMI ≥45 kg.m-2) women had 17 min longer total theatre time (p<0.001), 8 min longer surgical time (p<0.001) & 10 min longer anesthesia time (p<0.001) compared with normal BMI (23.5-<30 kg.m-2) women. Increased delivery BMI was associated with increased risk of maternal intensive care unit(ICU) admission (OR=1.07, p=0.046) but no increase in neonatal admission to higher acuity care(HDU). Total hospital, & theatre costs were increased by 15% (p=0.032) & 27% (p=0.001) respectively in super-obese compared to normal BMI women.
Conclusions:High BMI is associated with increased total theatre time, surgical & anesthesia time, increased maternal risk of ICU admission & increased total hospital & theatre costs. These clinical risks, time impacts & costs need to be considered in pregnant women. To do so we must record maternal BMI at term.