20 - Epidemic Maternal Obesity: Impact on Perinatal Morbidities and NICU Admission rates

Poster Number: 20
Publication Number: 20.338

Paul D. Winchester, IUSM, Bargersville, IN, United States; Catherine Proctor, Indiana University School of Medicine, Indianapolis, IN, United States

Background: Maternal obesity(BMI ≥30) in the US has risen by 28% in past 10 years. While many factors are acknowledged as contributors to this epidemic the fact of epidemic obesity increases the risk for maternal and neonatal adverse outcomes of pregnancy.

Objective: Document maternal pre-pregnancy obesity trends for past 10 years in US and measure the impact of increasing maternal obesity on adverse pregnancy outcomes.

Design/Methods: CDC natality data was abstracted from 2011-2020 where pre-pregnancy BMI, and maternal and neonatal outcomes were delineated. Analysis of BMI trends included all pregnancies but analysis of specific pregnancy and neonatal outcomes was limited to singleton live births born between 22 and 42 weeks of gestation.(n=34,461,202). Trends and outcomes were delineated by race, maternal age, inductions, c-sections, diabetes, hypertension, BMI category (normal, overweight, obesity I, II, Morbid obesity III,IV,V,VI by mother's prepregnancy BMI (range 18.5 to >55).Outcomes included: birth weight percentile (BWT%), 5 minute APGAR, gestational length, preterm birth (22-36wks),non-viable birth (17-21 wks) need for ventilation, NICU admission and death by time of data collection.

Results: Maternal BMI significantly increased from 2011 to 2020. Mean BMI rose fastest in Hisp >Black >White.   BMI and obesity(BMI >30) differed significantly by race White (27.2%) >Hispanic (33.5%) >Black(40.0%).  For all races % obese(≥30) rose by (27.9%) and morbidly obese(BMI >40) rose by 41.9%. As BMI increased from normal (18.5-24.9) to morbid obesity c-section rates rose from 25% to 67%, inductions from 245 to 33%, preterm births rates rose from 9% to 15% (p < .001), gestational length declined, birth weight %iles rose 22%,(from 44.4 to 54.2),5 minute APGAR scores declined, need for immediate ventilation increased 2.6x, ≥6 hr ventilation by 3x,surfactant 2.9x, risk of seizures by1.7x,antibiotics 1.8x, and NICU admission by 2.3x (from 6.7% to 15.6%).Conclusion(s): Maternal and neonatal morbidities are being directly impacted by the obesity epidemic. Significantly more resources will be needed to address obesity causes and treatments. It is anticipated that further increases in maternal morbidities and neonatal morbidities  can be expected unless major public health interventions are instigated to stem the rise in obesity.
Prepregnancy BMI 2011-2020Prepregnancy BMI 2011-2020
%Preterm Births vs Pre-pregnancy BMI% Preterm Births v Pre-pregnancy BMI