Impacts of Obesity on Maternal and Fetal Outcomes in Women with Singleton Pregnancy at a Nigerian Clinical Setting

Abstract

Background: Obesity, an emerging public health concern in maternity care with increasing prevalence even in developing countries is associated with maternal and perinatal complications. This study sought to evaluate the impact of maternal obesity on pregnancy outcomes in a cohort of Nigerian women. Study Design: A prospective cohort study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Bingham University Teaching Hospital Jos, between January 2013 and September 2014. Methodology: A study of matched 324 obese [Body mass index (BMI) ≥ 30 Kg/m2] and 324 non-obese women (BMI 18.5 – 24.9 Kg/m2) with singleton pregnancies recruited at the antenatal clinic during their first trimester. They were followed-up to the postpartum period to ascertain development of antenatal, intra-partum, postpartum and fetal complications. Chi square or Fisher’s Exact test and student t-test were done to ascertain any relationship between obesity and the outcome variables using SPSS version 16 (SPSS Inc., Chicago, IL, USA) and P value < 0.05 was considered statistically significant. Results: In comparison with pregnant women with normal BMI, obese women faced higher risk of developing antenatal complications (P = 0.001, Odds Ratio (OR) 5.32, 95% Confidence Interval (CI) 1.90 – 14.94) especially gestational hypertension and pre-eclampsia (P = 0.002, OR 4.66, 95% CI 1.65 – 13.19), having caesarean section (P = 0.043, OR 0.48, 95% CI 0.23 – 0.99) and macrosomic baby (P = 0.005, OR 3.40, 95% CI 1.41 – 8.19). However, no statistical difference with respect to risk of spontaneous miscarriage (P = 0.313, OR 3.08, 95% CI 0.31 – 30.22), preterm delivery (P = 0.167, OR 3.16, 95% CI 0.62 – 16.15), genital tract injury (P = 0.407, OR 0.76, 95% CI 0.40 – 1.46), postpartum haemorrhage (P = 0.199, OR 1.75, 95% CI 0.74 – 4.13), low birth weight babies (P = 0.732, OR 1.27, 95% CI 0.33 – 4.90) and stillbirth (P = 0.080, OR 0.96, 95% CI 0.92 – 1.01). Conclusion: Maternal obesity is associated with elevated risk of hypertensive disorders, caesarean delivery and fetal macrosomia. It is imperative to implement a policy of identifying these women as high risk group at this clinical setting so as to institute appropriate materno-fetal surveillance and management strategies aim at enhancing their pregnancy outcomes.