and cesarean section Birth by the Numbers Gene Declercq March 2016 Long Standing Concern with Maternal Obesity Contemporary Categorization of Obesity BirthByTheNumbersorg BMI amp Obesity Categories ID: 912885
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Slide1
Is there a relationship between pre-pregnancy obesityand cesarean section
Birth by the Numbers
Gene Declercq
March, 2016
Slide2Long Standing Concern with Maternal Obesity
Slide3Contemporary Categorization
of Obesity
BirthByTheNumbers.org
Slide4BMI & Obesity Categories
BMI
Category
Person 5’4”
<18.5
Underweight
< 110
lbs
18.5 – 24.9
Normal Weight
110-144
25.0 – 29.9Overweight145-17430.0 – 34.9Obese I175-20435.0 – 39.9Obese II205-23540+Obese III235+
BirthByTheNumbers.org
Slide5Trends in U.S. Obesity over Time
Slide6Obesity Trends* Among U.S. AdultsBRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Slide7Obesity Trends* Among U.S. Adults
BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Slide8Obesity Trends* Among U.S. Adults
BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Slide9Obesity Trends* Among U.S. Adults
BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Slide10Obesity Trends* Among U.S. Adults
BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Slide11Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Slide12Obesity Trends* Among U.S. Adults
BRFSS, 1991
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Slide13Obesity Trends* Among U.S. Adults
BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Slide14Obesity Trends* Among U.S. Adults
BRFSS, 1993
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Slide15Obesity Trends* Among U.S. Adults
BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Slide16Obesity Trends* Among U.S. Adults
BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Slide17Obesity Trends* Among U.S. Adults
BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Slide18Obesity Trends* Among U.S. Adults
BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
≥20%
Slide19Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
≥20%
Slide20Obesity Trends* Among U.S. Adults
BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
≥20%
Slide21Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
≥20%
Slide22Obesity Trends* Among U.S. AdultsBRFSS, 2001
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24%
≥25%
Slide23(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
Obesity Trends* Among U.S. Adults
BRFSS, 2002
No Data <10% 10%–14% 15%–19% 20%–24%
≥25%
Slide24Obesity Trends* Among U.S. Adults
BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24%
≥25%
Slide25Obesity Trends* Among U.S. Adults
BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24%
≥25%
Slide26Obesity Trends* Among U.S. Adults
BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Slide27Obesity Trends* Among U.S. Adults
BRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Slide28Obesity Trends* Among U.S. Adults
BRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Slide29Obesity Trends* Among U.S. Adults
BRFSS, 2008
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Slide30Obesity Trends* Among U.S. Adults
BRFSS, 2009
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Slide31Obesity Trends* Among U.S. Adults
BRFSS, 2010
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Why do maps stop in 2010?
Slide32Trends in Obesity,
US Adult Women
, 1988-2012
Source: NHANES surveys
BirthByTheNumbers.org
Slide33Prepregnancy Obesity, U.S. (sort of)* 2003, 2006, 2009, 2011*, 2013*
Sources: 2003-2009 -- S. Fisher. Is obesity still increasing among pregnant women?
Preventive Medicine
2013; 56: 372-378; 2011 & 2013 – CDC VitalStats.
* Based on different combinations of states in 2011 & 2013
BirthByTheNumbers.org
Slide34Term, Singleton, Vertex (TSV) , No prior Cesarean
Term – 37 + weeks gestation
Singleton – no twins
Vertex – no breech birthsNo prior cesarean
BirthByTheNumbers.org
Slide35BMI categories for Term, Singleton, Vertex births to mothers w/ no prior cesarean: 38 states & DC, 2012
Characteristic of mother
Under-weight
Normal weight
Overweight and obese
Total
Over-weight
Total Obese
Obese I
Obese II
Obese III
(BMI<18.5)
(BMI 18.5-24.9)
(BMI 25+)
(BMI 25.0-29.9)
(BMI 30+)
(BMI 30.0-34.9)
(BMI 35.0-39.9)
(BMI ≥40.0)
(N=88,638)
(N
=
1,066,630
)(N=1,002,074)(N=542,296)
(N=459,778)(N=266,872)(N=118,111)
(N=74,795)
All
4.1
49.446.425.1
21.312.45.53.5
Race and Hispanic origin
Hispanic
3.1
44.4
52.5
29.123.4
14.75.63.0Non-Hispanic
White
4.0
52.3
43.7
23.9
19.8
11.3
5.2
3.3
Black
3.7
38.7
57.6
27.1
30.5
16.18.0
6.3 AIAN3.1
37.1
59.827.332.517.7
9.15.7 Asian
9.566.923.5
17.56.14.7
1.0
0.3BirthByTheNumbers.org
Slide36Prepregnancy Obesity also related to:Being born in the U.S. (23%) rather than foreign born (15%)
Being on private insurance (25%) rather than Medicaid (19%)
Having only a high school education (25%) compared to a graduate degree (12%)
BirthByTheNumbers.org
Slide37Also related to how many kids you’ve had:Obesity by Live Birth Order, 2013
Live Birth Order
BirthByTheNumbers.org
Slide38How is BMI related to the likelihood of a cesarean?
BirthByTheNumbers.org
Slide39Unadjusted
Primary
Cesarean Rate TSV births to mothers with no prior cesarean: 38 states and DC, 2012
Source: CDC VitalStats, 2013.
BirthByTheNumbers.org
Slide40CS Rates for TSV mothers by BMI and Race/Ethnicity
BirthByTheNumbers.org
Slide41Overall relationship adjusted for:maternal age,
race/ethnicity
,
education, trimester prenatal care began,
nativity (US or foreign-born), method of payment for the delivery, pre-pregnancy and gestational diabetes and hypertension.
BirthByTheNumbers.org
Slide42Adjusted~ risk ratios^ for CS by BMI, TSV* Mothers w/ no Prior CS, 38 states, 2012
~ Adjusted for maternal age, race/ethnicity, education, trimester prenatal care began, nativity (US or foreign-born), method of payment for the delivery, and pre-pregnancy and gestational diabetes and hypertension.
^ “Normal weight” (BMI 18.5-24.9) was the reference group; Error Bars represent 95% Confidence Intervals.
*Singleton, vertex, 37-41 weeks of gestational age. LBO = live birth order
BirthByTheNumbers.org
Slide43ConclusionBMI retains a significant impact on the likelihood of a CS, even after controlling for socio-demographic and medical risks
Robust relationship that was consistent across different analyses of subgroups (e.g. mothers without diabetes or hypertension)
What about outcomes? Future
Birth by the Numbers video
BirthByTheNumbers.org
Slide44Follow Birth by the Numbers on Social Media:
RSS (blog):
www.birthbythenumbers.org
www.facebook.com/BirthByTheNumbers
Twitter: @
BirthNumbersEmail: birthbynumbers@gmail.com“Birth by the Numbers
” on Pinterest
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