| Autor: |
Aubry EM; Health Department, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland. Evelyne.aubry@bfh.ch., Oelhafen S; Health Department, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland., Fankhauser N; CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, CH-3012, Bern, Switzerland., Raio L; Department of Obstetrics and Gynecology. Inselspital, University of Bern, Bern, Switzerland., Cignacco EL; Health Department, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland. |
| Abstrakt: |
Maternal obesity often occurs together with comorbid diabetes and hypertensive disorders. All three conditions are independently associated with negative perinatal outcomes. Our objective was to determine the risk and burden of adverse perinatal outcome that could be attributed to maternal obesity in combination with a comorbid status. We analyzed data from 324'664 singleton deliveries in Switzerland between 2005 and 2016. For the association of maternal obesity in the presence or absence of comorbidities with various perinatal outcomes, we estimated adjusted relative risk (RR) using multivariable regression modeling and determined the multivariable-adjusted attributable fraction of the population (AFp). Obesity was a main predictor for macrosomia, fracture of the clavicle, failure to progress in labor and prolonged labor. By stratifying women based on comorbidities, we identified significantly increased risk for preterm birth and early neonatal death only for women diagnosed with a comorbidity. However, various other outcomes were independently associated with either obesity or comorbidities. The AFp showed greatest reduction in comorbidities (15.4/15.0/13.2%), in macrosomia (6.3%) and in shoulder dystocia (4.8%) if all women were to become non-obese. We suggest that comorbidities such as diabetes and hypertensive disorders should be considered when relating maternal obesity to adverse perinatal outcomes. |
