Obesidade e ganho de peso gestacional : cesariana e complicações de parto

Ganho de peso excessivo mostrou a maior associação com cesariana entre obesas (RR=2,2; IC 95%: 1,4-3,2) para 4o vs 2o quartil. Maior peso pré-gravídico esteve associado com risco ajustado significativamente aumentado para mecônio no parto vaginal e com prematuridade, morte perinatal ou infecção na cesariana. Similarmente, grande ganho de peso aumentou o risco para mecônio e hemorragia materna no parto vaginal e com prematuridade na cesariana. CONCLUSÕES: A obesidade pré-gestacional e o ganho de peso excessivo aumentaram de forma independente o risco de cesariana e vários resultados adversos durante o parto vaginal. Esses achados oferecem evidências adicionais aos efeitos negativos da obesidade pré-gravídica e do ganho de peso excessivo na gravidez e parto.OBJECTIVE: To assess the association between pre-gestational obesity and weight gain with cesarean delivery and labor complications. METHODS: A total of 4,486 women 20-28 weeks pregnant attending general prenatal care clinics of the national health system in Brazil from 1991 to 1995 were enrolled and followed up through birth. Body mass index categories based on prepregnancy weight and total weight gain were calculated. Associations between body mass index categories and labor complications were adjusted through logistic regression analysis. RESULTS: Obesity was present in 308 (6.9%) patients. Cesarean delivery was performed in 164 (53.2%) obese, 407 (43.1%) pre-obese, 1,045 (35.1%) normal weight and 64 (24.5%) underweight women. The relative risk for cesarean delivery in obese women was 1.8 (95% CI: 1.5-2.0) compared to normal weight women. Greater weight gain was particularly associated with cesarean among the obese (RR 4th vs 2nd weight gain quartile 2.2; 95% CI: 1.4-3.2). Increased weight at the beginning of pregnancy was associated with a significantly higher adjusted risk of meconium with vaginal delivery and perinatal death and infection in women submitted to cesarean section. Similarly, greater weight gain during pregnancy increased the risk for meconium and hemorrhage in women submitted to vaginal delivery and for prematurity with cesarean. CONCLUSIONS: Pre-gestational obesity and greater weight gain independently increase the risk of cesarean delivery, as well as of several adverse outcomes with vaginal delivery. These findings provide further evidence of the negative effects of prepregnancy obesity and greater gestational weight gain on pregnancy outcomes