Evaluation of Maternal, Fetal and Neonatal Complications according to Body Mass Index in Women Referred to Shiraz Health Choice Centers, 2009

Document Type : Original Article


1 M.Sc. of Midwifery, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.

2 M.Sc. of Midwifery, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.

3 PhD. Student of Vital Statistics, Faculty of Health, Tehran University of Medical Sciences, Tehran, Iran.


Introduction: Obesity is a risk factor for pregnant women and fetus, undoubtedly. Maternal obesity is one of the important risk factors related to maternal and fetal mortality followed with extensive range of medical complications.
The purpose of this study was the evaluation of maternal, fetal and neonatal complications according to BMI in women referred to Shiraz health choice centers.
Methods: This descriptive study was done on 860 delivered women admitted in post partum ward of Hafez and Zeinabieh hospitals in Shiraz. Women were divided in 2 groups according to preconception of BMI: Group 1 with normal weight (19.8< BMI≤25), and group 2 with abnormal weight (BMI>25). Participants were studied for age, parity, pregnancy complications, parturition and neonatal complications.
Results: Mean age was 26.9±5.39 yrs. 68.3% (608) of women had normal BMI and 31.7% (282) had abnormal BMI. The most common complication during pregnancy was back pain 25.4% (226). The prevalence of back pain, high blood sugar, hypertension, induced labor, post partum hemorrhage, post partum infection, duration of hospitalization , cesarean section and neonatal apnea were higher in abnormal weight group than normal weight group which the difference of variables was significant between two groups (p<0.05). The most odds ratio was post partum infection which the possibility of post partum infection in abnormal weight group was 179.8 times in compare to the normal weight group (95% CI: 85.5-378).
Conclusion: Obesity is an important risk factor in pregnant women followed with adverse maternal, neonatal and fetal outcomes.


2. Wang Y, Beydoun MA, Liang L, Caballero B, Kumanyika SK. Will all Americans become overweight or obese?
estimating the progression and cost of the US obesity epidemic. Obesity (Silver Spring). 2008 Oct;16(10):2323-30.
Epub 2008 Jul 24.
3. Ota E, Haruna M, Suzuki M, DucAnh D, Tho LH, Thanh Tam NT, etal. Maternal body mass index and gestational
weight gain and their association with perinatal outcomes in VietNam. Bull World Health Organ 2011, 89(2): 127–
4. Wolfe H. High prepregnancy body-mass index — a maternal–fetal risk factor. N Engl J Med 1998; 338: 191-192.
5. Kaiser PS, Kirby RS. Obesity as a risk factor for cesarean in a low-risk population. Obstet Gynecol 2001; 97: 39-43
6. Young TK, Woodmansee B. Factors that are associated with cesarean delivery in a large private practice: the
importance of prepregnancy body mass index and weight gain. Am J Obstet Gynecol 2002; 187: 312-318; discussion
7. Ehrenberg HM, Durnwald CP, Catalano P, Mercer BM. The influence of obesity and diabetes on the risk of cesarean
delivery. Am J Obstet Gynecol 2004; 191: 969-974.
8. Galtier-Dereure F, Boegner C, Bringer J. Obesity and pregnancy: complications and cost. Am J Clin Nutr 2000;
71(5 Suppl): S1242-S1248.
9. Rosenberg TJ, Garbers S, Chavkin W, Chiasson MA. Prepregnancy weight and adverse perinatal outcomes in an
ethnically diverse population. Obstet Gynecol 2003; 102(5 Pt 1): 1022-1027.
10. Rowlands I, Graves N, de Jersey S, McIntyre HD, Callaway L. Obesity in pregnancy: outcomes and economics.
Semin Fetal Neonatal Med 2010; 15(2):94-9.
11. Rodline Lisbet N. Midwifery, obesity-Relaited complication in Danish single cephalic term pregnancy. 2006;107(76):
12. Sebrire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M, Beard RW, et al. Maternal obesity and pregnancy outcome: a
study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord 2001; 25(8): 1175-82.
13. Hilson JA, Rasmussen KM, Kjolhede CL. Excessive weight gain during pregnancy is associated with earlier
termination of breast-feeding among white women. J Nutr 2006; 136(1): 140-6.
14. Li C, Kaur H, Choi WS, Huang TT, Lee RE, Ahluwalia JS. Additive interactions of maternal pregnancy BMI and
breast-feeding on childhood overweight. Obs Res 2005; 13(2): 362-71.
15. Hediger ML, Overpeck MD, McGlynn A, Kuczmarski RJ, Maurer KR, Davis WW. Growth and fatness at three to six
years of age of children born small-or large-for-gestational age. Pediatrics 1999; 104(3): e33.
16. Denison FC, Price J, Graham C, Wild S, Liston WA. Maternal obesity, length of gestation, risk of postdates
pregnancy and spontaneous onset of labour at term. BJOG 2008;115(6): 720-5.
17. Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ. Pre- pregnancy weight and the risk of stillbirth
and neonatal death. BJOG 2005; 112(4): 403-8.
18. Juhasz G, Gyamfi C, Gyamfi P, Tocce K, Stone JL. Effect of body mass index and excessive weight gain on success
of vaginal birth after cesarean delivery. Obstet Gynecol 2005; 106(4): 741-6.
19. Stothard KJ, Tennant PW, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a
systematic review and meta-analysis. JAMA 2009; 301(6): 636-50.
20. Werler MM, Louik C, Shapiro S, Mitchell AA. Pregnant weight in relation to risk of neural tube defects. JAMA
1996; 275(14): 1089-92.
21. Rossner S, Ohlin A. Pregnancy as a risk factor for obesity: lessons from the Stockholm pregnancy and weight
development study. Obes Rese 1995; 3 Suppl 2:267s-275s.
22. Garrow J. Importance of obesity. BMJ 1991; 303(6804):704-6.
23. Heslehurst N, Simpson H, Elis LJ, Rankin J, Wilkinson J, Lang R, et al. The impact of maternal BMI status on
pregnancy outcomes with immediate short-time obstetric resource implications: a meta-analysis. Obes Rev 2008;
9(6): 635-83.
24. Clark AM, Ledger W, Gallety C, Tomlinson L, Blaney F, Wang X, et al. Weight loss results in significant
improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reorod 1995; 10(10): 2705-12.
25. Callaway K, Prins JB, Chang AM, Mclntyre HD. The prevalence and impact of overweight and obesity in an
Australian obstetric population. Med J Aust 2006; 184(2): 56-9.
26. O’Brien TE, Ray JC, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview.
Epidemiology 2003; 14(3): 368-74.
27. James AH, Jamison MG, Brancazio LR, Myers ER. Venous thromboembolism during pregnancy and the postpartum
period: incidence, risk factors, and mortality. Am J Obstet Gynecol 2006; 194(5):1311-15.
28. Maasilta P, Bachour A, Teramo K, Polo O, Laitinen LA. Sleep-related disordered breathing during pregnancy in
obese women. Chest. 2001; 120(5):1448-54.
29. Hendler I, Schatz M, Momirova V, Wise R, Landon M, Mabie W, et al. Association of obesity with pulmonary and
nonpulmonary complications of pregnancy in asthmatic women. Obstet Gynecol 2006: 108(1):77-82.
30. Ko CW, Beresford SA, Schulte SJ, Matsumoto AM, Lee SP. Incidence, natural history, and risk factors for biliary
sludge and stones during pregnancy. Hepatology 2005; 41(2): 359-65.
31. Albert HB, Godskesen M, Korsholm L, Westergaard JG. Risk factors in developing pregnancy- related pelvic girdle
pain. Acta Obstet Gynecol Scand 2006; 85(5): 539-44.
32. D’Alfonso A, Iovenitti P, Carta G. Urinary disorders during pregnancy and postpartum: our experience. Clin Exp
Obstet Gynecol 2006; 33(1): 23-5.
33. Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004; 103(2):
34. Mclean M, Bisits A, Davies J, Woods R, Lowry P, Smith R. A placental clock controlling the length of human
pregnancy. Nat Med 1995; 1(5):460-3.
35. .Seabra G, Padilha Pde C, Queiroz JA, Saunders C[Pregestational overweight and obesity: prevalence and outcome
associated with pregnancy]. Rev Bras Ginecol Obstet. 2011 Nov;33(11):348-53.
36. Ljung T, Holm G, Friberg P, Andersson B, Bengtsson BA, Svensson J, et al. The activity of the hypothalamicpituitary-adrenal
axis and the sympathetic nervous system in relation to waist/hip circumference ratio in men. Obes
Res 2000; 8(7): 487-95.
37. Jessop DS, Dallman MF, Fleming D, Lightman SL. Resistance to glucocorticoid feedback in obesity. J Clin
Endocrinol Metab 2001; 86(9): 4109-14.
38. Strain GW, Zumoff B, Kream J, Strain JJ, Levin J, Fukushima D. Sex difference in the influence of obesity on the 24
hr mean plasma concentration of cortisol. Metabolism 1982; 31(3): 209-12.
39. Ehrenberg HM, Huston-Preseley L, Catalano PM. The influence of obesity and gestational diabetes mellitus on
accretion and the distribution of adipose tissue in pregnancy. Am J Obstet Gynecol 2003; 189(4): 944-8.
40. Ehrenberg HM, Mercer BM, Catalano PM. The influence of obesity and diabetes on the prevalence of macrosomia.
Am J Obstet Gynecol 2004; 191(3): 964-8.
41. Nohr EA, Bech BH, Davies MJ, Frydenberg M, Henriksen TB, Olsen J. Pregnancy obesity and fetal death: a study
within the Danish National Birth Cohort. Obstet Gynecol 2005; 106(2): 250-9.
42. Polotsky VY, Li J, Punjabi NM, Rubin AE, Smith PA, Schwartz AR, et al. Intermittent hypoxia increases insulin
resistance in genetically obese mice. J physiol 2003; 552(Pt 1): 253-64.
43. Nayak AS. A common pathway: asthma and allergic rhinitis. Allergy Asthma Proc 2002; 23(6): 359-65.
44. Aro S, Leino P. Overweight and musculoskeletal morbidity: a ten-year follow-up. Int J Obes 1985; 9(4): 267-75.