Maternal-Foetal Complications in Pregnant Women with Obesity: a predictive model

Maternal-Foetal Complications in Pregnant Women with Obesity: a predictive model | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Maternal-Foetal Complications in Pregnant Women with Obesity: a predictive model Alba Díez-Ibarbia, Juan Manuel Odriozola-Feu, Eva Díez-Paz, Carmen Sarabia-Cobo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4691249/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Obesity is a recognised global epidemic with serious consequences, including increased risk of morbidity and reduced life expectancy. It is a chronic, multifactorial disease defined by a Body Mass Index ≥ 30 kg/m 2 . It also imposes a significant economic burden on individuals, families and countries. During pregnancy, maternal obesity is a significant risk factor, making pregnancy a vulnerable period for obese women, potentially worsening its course and having adverse effects on both mother and foetus. In addition, the offspring of obese pregnant women are at increased risk of obesity in childhood and adulthood. Therefore, the aim of this study was to describe the maternal and neonatal consequences and morbidity associated with maternal obesity in pregnant women in the community of Cantabria, northern Spain, in the post-pandemic era. Methods This was achieved through a retrospective observational descriptive study of pregnant women who gave birth at the Marqués de Valdecilla University Hospital in Cantabria during the years 2021 and 2022. STROBE's COREQ recommendations were followed. Results No significant differences were found in the incidence of diseases during pregnancy and postpartum between 2021 and 2022. However, a significant difference was found in the need for Neonatal Intensive Care Unit admission, with a higher proportion of newborns admitted to the Neonatal Intensive Care Unit in 2022. The classification model suggests that diseases during pregnancy, especially Hypertension arterial, complications during labor (with hemorrhage as the main one), and the reason for cesarean section, Risk of Foetal Well-being Loss, are significant predictors of the type of delivery. A significant increase in the frequency of all treatments was observed during the puerperium compared to gestation. Conclusions Obesity increases the risk of presenting diseases and complications during pregnancy, childbirth and neonatal risks. Therefore the pregnancy is a conflict for public health because it increases obstetric. Pregnant women Maternal obesity Obstetric complications Maternal morbidity Neonatal morbidity INTRODUCTION As a summary, it should be noted that in this study significant results were found in the sense that obese pregnant women have a higher risk of diseases during pregnancy, complications during childbirth and a significant increase in the frequency of all treatments during the postpartum compared to pregnancy. Obesity is a serious public health problem, refered to as the new non-communicable epidemic of the 21st century and defined by The Obesity Society as a disease that not only underlies major chronic diseases, but is also a severely debilitating condition in its own right.[ 1 ] During pregnancy, maternal obesity emerges as a major risk factor. This period, characterised by transient physiological changes, becomes even more sensitive when combined with obesity, which may exacerbate risks for both mother and fetus.[ 2 , 3 ] Maternal complications associated with obesity during pregnancy include pre-eclampsia, gestational diabetes, venous thromboembolism and postpartum haemorrhage.[ 4 , 5 , 6 , 7 , 8 ] For the foetus, complications can range from heart defects to metabolic problems and even increase the risk of congenital anomalies and foetal death.[ 9 , 10 ] In addition, children of obese women are at increased risk of obesity in childhood and adulthood [ 11 ] and may be at increased risk of congenital anomalies and metabolic complications. [ 12 , 13 , 14 ] The COVID-19 pandemic has introduced additional challenges, affecting health systems and potentially altering obesity rates in pregnant women. [ 15 ] Understanding how the pandemic has affected the prevalence and management of obesity in this group is essential to tailor clinical interventions to meet the changing needs of these women. [ 16 ] Therefore, the aim of this study is to analyse the maternal and neonatal consequences and morbidities associated with maternal obesity in the community of Cantabria, northern Spain, during the post-pandemic period (2021–2022). This knowledge will help health professionals to be aware of the risks associated with maternal obesity and to develop effective strategies to manage pregnancy in obese women, in order to reduce or prevent complications in both mother and child. METHODOLOGY Study design A retrospective observational descriptive study was conducted in 2021 and 2022 among pregnant women who gave birth at the Marqués de Valdecilla University Hospital, a public hospital in northern Spain. Study subjects The sample selected was all women who had given birth at the hospital and who had a body mass index (BMI) greater than or equal to 30 before pregnancy. STROBE's COREQ recommendations were followed. Inclusion and exclusion criteria Inclusion criteria were women with a pre-pregnancy BMI greater than or equal to 30 (obesity) who gave birth in 2021 and 2022 at the Marqués de Valdecilla University Hospital, Cantabria Health Service. Exclusion criteria were women who fulfilled the main condition of not being considered obese at the time of pre-pregnancy (BMI greater than or equal to 30) or whose BMI was not recorded in the Altamira computer programme (Electronic Health Record of the Cantabrian Health System). Variables Gestational variables: Whether they had received any treatment during pregnancy and, if so, the most common treatments were examined, including anticoagulants, antihypertensives and insulin. Variables on any illness during pregnancy were also collected, looking at the most common conditions such as gestational hypertension (PIH), gestational diabetes mellitus (GDM), hypothyroidism and hyperthyroidism. With regard to ultrasound scans performed during pregnancy, the results of ultrasound pathologies, foetal growth abnormalities, mean foetal percentile and number of fetuses diagnosed were studied. Labour: The type of delivery, vaginal or caesarean, was analysed. For vaginal deliveries, the prevalence of ectopic and instrumental deliveries and the reasons for dystocia were studied. For caesarean section, the reasons for caesarean section were examined, distinguishing between emergency caesarean section and planned caesarean section. Any complications during labour were also recorded in detail. Postpartum: complications such as anaemia, pre-eclampsia, hypertensive disorders, infection, wound dehiscence or bleeding, urinary pathology, postpartum fever, sepsis and postpartum haemorrhage were studied. Treatment during this period was also analysed, the most common being anticoagulants and antihypertensives. Neonatal variables: Whether they required admission to the neonatal intensive care unit (NICU) and, if so, the most common reasons, such as respiratory distress, prematurity, neonatal jaundice, low birth weight, hypoglycaemia, maternal admission to NICU, infection, hypotonia, and neonatal death. Data Collection Procedure Data collection was carried out from February to May 2023 using the Altamira Software Program of the Cantabrian Health Service. All healthcare episodes recorded in the patients' medical records providing relevant information on the subject were systematically reviewed. Ethical considerations With regard to ethical considerations, authorisation has been obtained from the Research Ethics Committee of the Community of Cantabria (code: 2022.344 and date of approval: 16/12/2022), the Head of the Gynaecology Service and the Head of the Maternity Unit of the Marqués de Valdecilla University Hospital for the collection of data relating to her pregnancy, delivery and postpartum history. The data will be processed in such a way as to guarantee the confidentiality of the data and information contained in the study, in accordance with current Spanish legislation. The regulations of the ethics committee of the Cantabrian Health Service as well as the regulations in Spain establish that the authorisation of the hospital and the ethics committee is required exclusively for the collection of clinical history data, given that the data accessed by the researcher are disaggregated when obtained from the computer system: they do not contain personal data and therefore authorisation cannot be requested, as they are collected retroactively. The researchers are responsible for ensuring that the data obtained cannot be used for other purposes. Statistical analysis SPSS v.22 was used. A statistical significance level of α = 0.05 was used to assess the importance of the differences observed and to determine whether the results were statistically significant. Appropriate statistical tests were used, such as Chi-square tests for categorical variables and Student's t-tests or analysis of variance (ANOVA) for continuous variables, as appropriate. Correlation studies between the variables as well as logistic regression modelling were carried out to determine possible predictive values. RESULTS A total of 920 records meeting the criteria were collected, of which 479 were from 2021 and 439 from 2022. The total number of deliveries attended was 2,768 in 2021 and 2,679 in 2022, giving a total of 5,447 deliveries. Therefore, the percentage of pregnant women with obesity was 17.30% in 2021 and 16.38% in 2022. A comparison of proportions test was performed to determine whether there were significant differences in the incidence of pregnancy-related morbidity, postpartum complications, and the need for NICU admission between 2021 and 2022. No significant differences were found in the incidence of diseases during pregnancy between 2021 and 2022 (p > 0.05). Similarly, no significant differences were observed in the prevalence of postpartum complications between the two years (p > 0.05). However, a significant difference was found in the need for NICU admission between 2021 and 2022 (p < 0.05), with a higher proportion of newborns admitted to the NICU in 2022. Gestational stage Table 1 shows the variables collected in relation to diseases presented during this period, pathologies detected by ultrasound and foetal growth abnormalities. The mean ultrasound percentile was 63 (SD: 28.23). The mean number of foetuses diagnosed by ultrasound was 1.028 (SD: 0.18). Table 1 Variables of the Gestational Stage (N = 920). Gestational Stage Diseases during pregnancy No diseases 37.8% PIH 37.8% GDM 10.1% Gestational hypothyroi dism 10.1% Gestational hyperthyroidism 3.7% Pathologies in Ultrasound No pathologies 88% Yes, they had pathologies 11.1% Placental alteration 0.5% Foetal static alteration 0,4% T Foetal Growth Abnormalities No abnormalities 69.8% Macrosomia 23.8% Intrauterine growth restriction 3.6% Small for gestational age 1.9% Labor A classification model was developed using gestational and labor variables to predict the type of delivery (eutocic, instrumental, or cesarean). The results of the model identified the following significant predictor variables: Diseases during pregnancy (p = .021); Complications during labor (p = .003), and reason for cesarean section (p = .012). The classification model suggests that diseases during pregnancy, especially Hypertension arterial (HTN), complications during labor (with hemorrhage as the main one), and the reason for cesarean section, Risk of Foetal Well-being Loss (RFWL), are significant predictors of the type of delivery. A regression analysis was conducted using gestational and ultrasound variables to predict the mean foetal percentile. Significant predictor variables were: Diseases during pregnancy (β = − .27, p = .004), Pathologies in ultrasound (β = − .21, p = .019), Complications during labor (β = − .19, p = .032). Adjusted R^2 = .362. The regression analysis suggests that diseases during pregnancy (especially HTN), pathologies in ultrasound (placental alteration), and complications during labor (hemorrhage) are significant predictors of the mean foetal percentile. Table 2 lists the variables collected regarding the type of delivery, reasons for instrumentalized delivery, cesarean deliveries, and the reason and complications. Table 2 Birth variables (N = 920). BIRTH Type of delivery Eutocic 63.7% Instrumental 7.0% Cesarean 29.3% Total vaginal delivery 70.7% Instrumentalized delivery Metal suction cup 3.2% Kiwi Suction Cup 3.1% Forceps 0.8% Reasons for instrumentalized delivery RFWL 47.5% Stationary delivery 49.2% Induction failure 1.7% Cesarean deliveries Urgent 20.9% Programmed 8.4% Reason cesarean deliveries RFWL 27.5% Stationary delivery 14.7% Induction failure 18.5% Cephalopelvic disproportion 14.7% Buttocks 19.4% Complications No 87.8% Yes 12.2% Type of complications Postpartum hemorrhage 4.8% Hypertensive state 0.5% Others 6.9% Postpartum Postpartum complications 61.2% had some type of pathology compared with 38.8% of women who had no postpartum complications. Of the women with postpartum complications, most had anaemia (82.8%). About 35.5% had pre-eclampsia and 27.4% had HTN. Regarding the Caesarean wound, 13.1% had infection, 6.3% had dehiscence and 1.4% had bleeding from the incision. Eight per cent had some type of urinary pathology, mainly infection or urinary retention. Among obese postpartum women, 7.3% had puerperal fever, 1.7% had sepsis, 1.2% had severe puerperal haemorrhage and 15.6% had other pathologies. Logistic regression analysis was performed to determine whether there was a significant association between antenatal conditions and postpartum complications. A significant association was found between the presence of gestational disorders (such as PIH, GDM and anaemia) and the likelihood of complications in the puerperium (F(1,92) = 13.25, p = .02). For example, women with PIH had an increased risk of developing pre-eclampsia during the puerperium (up to 2 times higher). A multinomial logistic regression model was run to see if ultrasound pathologies had any effect on the mode of delivery. We found that ultrasound pathologies (such as foetal growth abnormalities) were significantly associated with the type of delivery (ectopic, instrumental or caesarean) (F (1,92) = 21.57, p < .001). For example, fetuses diagnosed with macrosomia (weight greater than 4000 grams) were more likely to be delivered by caesarean section (up to 0.9 times more likely) than fetuses without foetal growth restriction. A logistic regression model was constructed using the presence of complications during the puerperium as the dependent variable and the predictor variables mentioned above. The results of the model were the following significant predictor variables: Presence of illness during gestation (β = 1.25, p < .001); Type of delivery (β = .87, p = .003); Pathologies on ultrasound (β = 0.94, p = .002) and complications during labour (β = 1.10, p < .001). Adjusted R^2 = .421 (indicating that the model explains 42.1% of the variability in the presence of complications during the puerperium). The corrected logistic regression model suggests that the presence of gestational disease (especially HTN) and complications during labour (notably haemorrhage) are the strongest predictors of postpartum complications. Medication Table 3 shows the most frequent pharmacological treatments both during pregnancy and postpartum. The most frequent were anticoagulants, iron, antihypertensives and insulin. In the postpartum period all treatments increased markedly, especially anticoagulants and iron, which more than doubled. Table 3 Pharmacological treatment in pregnancy and puerperium (N = 920). Treatment during gestation Treatment during puerperium Has taken any treatment 41.4% 43.6% Anticoagulant 33.9% 64.6% Iron 20.7% 62.7% Antihypertensive 14.6% 17.6% Insulin 9.0% 11.2% Significant differences were found in the frequency of drug treatments (anticoagulants, iron, antihypertensives and insulin) between gestation and puerperium (F (1,36) = 11.32, p = .03). Specifically, a significant increase in the frequency of all treatments was observed during the puerperium compared to gestation (p = .032). Newborn After birth in the delivery room, the immediate puerperium lasted approximately one and a half hours, during which time the vast majority of newborns did not require admission to the NICU in 91.8% of cases, and 8.2% required admission to the NICU. Once this period had elapsed and the mother and newborn were transferred to the maternity ward, 11.8% of newborns were admitted to the NICU and 88.2% did not require admission. Regarding the reasons for admission of newborns to the intensive care unit, the most frequent was respiratory distress in 22.1% of the babies, followed by 15% for prematurity, and neonatal jaundice in 12.4%. Also, 11.5% of babies born to obese mothers were admitted for low neonatal weight, 9.7% for hypoglycaemia, 8.8% because the mother had to be admitted to the intensive care unit, 3.5% for hypotonia, 1.8% for infection and 13.3% for other types of reasons. Neonatal death occurred in 1.8% of infants born to obese mothers. A logistic regression analysis was performed to investigate whether maternal obesity has any significant impact on the need for NICU admission and reasons for admission. Maternal obesity was found to be significantly associated with the need for NICU admission (F (1,69) = 28.21, p < .001). In addition, infants born to obese mothers were found to be at increased risk of NICU admission due to conditions such as respiratory distress and prematurity (up to 1.2 times higher). DISCUSSION We will make a comparative study of the results of the variables both in gestation, labour and puerperium of the present study with those of other authors. The results of the gestational pathologies examined in our study show that only 37.8% had no pathology. The main pathologies were PIH, GDM, gestational hypothyroidism and gestational hyperthyroidism. The literature found [ 2 , 17 , 18 , 19 , 20 ] all point in the same direction: obese pregnant women have a significantly higher risk of obstetric complications than pregnant women with a normal BMI. These articles report that in terms of maternal complications, the risk of developing PIH, GDM, pre-eclampsia, hypothyroidism, hyperthyroidism, post-term pregnancy, caesarean section, preterm birth, post-partum haemorrhage, pelvic infection, urinary tract infection and macrosomia. Studies [ 2 , 21 , 22 , 23 ] mainly conclude an increased risk of developing GDM and PIH in overweight or obese pregnant women. In addition, Manrique Camasca LV [ 24 ] found that urinary tract infection was the most common obstetric complication, followed by anaemia and pre-eclampsia. Regarding ultrasound during pregnancy, in our study, 88% of ultrasounds performed during pregnancy showed no pathology, and the most common changes found were in the placenta and foetal statics. In our study, 23.8% of the foetal growth abnormalities were diagnosed as macrosomic foetuses, 3.6% as foetal growth restriction foetuses and 1.9% as Small for gestational age foetuses (SGA). The articles studied show that foetal weight was higher in overweight and obese pregnant women than in normal weight women. Foetal macrosomia, defined as was more frequent in overweight and obese pregnant women compared to normal weight pregnant women.[ 17 ] A higher incidence of foetal macrosomia is observed in obese pregnant women.[ 25 ] A relationship with shoulder dystocia has also been found.[ 26 ] The results of the variables relating to labour show that in our study most women had a vaginal delivery, the majority of which were ectopic vaginal deliveries. Caesarean section was 29.3%. Regarding vaginal delivery, in our study, the majority of reasons for instrumental delivery were due to induction failure, RFWL and induction failure. Evidence [ 27 ] suggests that there appears to be evidence of reduced uterine contractility in obese pregnant women compared to normal weight pregnant women. In the study by Medero Canela et al [ 28 ] carried out in Andalusia on obese pregnant women, the mode of delivery was mainly vaginal in 71.5% compared with 28.6% that ended in caesarean section. The complications that led to instrumental deliveries were mainly obstructed labour (49.2%) and foetal distress (47.5%). In the study by Kutchi et al [ 13 ] obese women were 4.69 times more likely to experience prolonged labour. In this study, instrumental deliveries were more common in non-obese subjects, although not statistically significant, while most researchers, [ 22 , 23 ] found an increased risk of operative vaginal deliveries in obese subjects. BMI at the end of pregnancy was lower in women with successful vaginal delivery, as in most studies. [ 29 , 30 ] This means that the higher the maternal weight, the lower the probability of vaginal delivery. Regarding caesarean delivery, in our study, the main reason for indicating caesarean delivery is for RFWL, followed by mal breech position, induction failure, stationary delivery and Cephalopelvic disproportion. Most of the articles found are along the same lines. In particular, obesity is a significant risk for both planned and emergency caesarean deliveries [ 31 ]. Studies have consistently shown higher rates of caesarean section in obese women compared to those with a normal BMI. [ 17 , 32 ] In relation to the type of delivery, several studies conducted in Spain and other countries [ 17 , 33 ] show an increased risk of instrumental deliveries and caesarean sections in overweight and obese pregnant women compared to those of normal weight, which increases as the BMI increases. In terms of complications during labour, our article details that the majority of women did not have any type of complication, compared to 12.2% who had complications during this process. The most common complications were postpartum haemorrhage and hypertensive disorders. In the study by Kutchi et al [ 13 ] postpartum haemorrhage was found to be 2.21 times more common in obese subjects, while the risk of pre-eclampsia increased 9.2 times.[ 34 ] Concluded in their study that obese nulliparous women have twice the risk of major postpartum haemorrhage, regardless of the mode of delivery. The increased postpartum haemorrhage may be due to a larger placental implantation surface area or a large volume of distribution and reduced bioavailability of uterotonic agents. A systematic review [ 35 ] concluded that overweight or obese mothers have a higher risk of preterm birth than mothers with a normal BMI. Obese pregnant women [ 36 ] are at increased risk of a range of maternal and perinatal complications, and this risk increases with the degree of obesity. Obesity in the postpartum period has short and long-term consequences for both the mother and the newborn. The following are the results found in the different studies: Regarding maternal complications in the postpartum period in our study, as detailed in the results, 61.2% had some type of pathology. Among these, a significant association was found between the presence of gestational disorders (such as PIH, GDM and anaemia) and the likelihood of having complications in the puerperium. With regard to the caesarean wound, the main complications were infection and dehiscence. It should also be noted that all treatments increased dramatically in the postpartum period, especially anticoagulant treatments and iron, which more than doubled. Several articles deal with this issue and find similar results. In the study by Medero Canela et al [ 28 ] in the postpartum period, 2.6% had wound infection, 1.6% haemorrhage and 0.7% suture dehiscence. In the study of the Hospital de Loreto, [ 32 ] 46.2% of pregnant women with grade I obesity presented some obstetric complication. The most frequent complications were urinary tract infection (40.4%), caesarean section (38.5%), anaemia (23.1%), perineal tear (19.2%), PIH (13.5%) and pre-eclampsia (13.5%). In other studies, [ 37 ] showed that postpartum haemorrhage is more frequent in obese women. In the "Obstetric care protocol on obesity and pregnancy" by the S.E.G.O.[ 38 ] the main causes of maternal mortality, such as pre-eclampsia, postpartum haemorrhage and obstructed labour are significantly increased by obesity. Therefore, there is an indirect influence between obesity and maternal or foetal mortality. In the study by Rodriguez Mantilla [ 39 ] one of the factors that was not associated with anaemia in postpartum women was gestational obesity. In the study by Kutchi et al, [ 13 ] the risk of GDM was 4.85 times higher among obese pregnant women with 12.46 times higher risk of requiring insulin. The postpartum period,[ 40 ] remains a high-risk period for obese women (endomyometritis, wall infection and thromboembolism). Universal assessment of thrombotic risk in the immediate postpartum period should be performed in all pregnant women. Regarding neonatal complications, our study found that maternal obesity is significantly associated with the need for NICU admission. In addition, neonates born to obese mothers were found to have an increased risk of NICU admission due to conditions such as respiratory distress and prematurity (up to 1.2 times higher). Much of the literature reviewed shows that infants born to obese mothers require more admissions to the neonatal unit and therefore more associated complications. Based on the literature consulted 41 there is no doubt that there is a positive relationship between maternal obesity and perinatal outcomes, which put not only the life of the pregnant woman at risk but also the development of the foetus and neonate at birth. The meta-analysis of Camacho Prieto et al, [ 41 ] demonstrated an increase in foetal weight and foetal macrosomia in overweight and obese pregnant women. The risk of foetal macrosomia increases with BMI. These same results have been corroborated by other authors [ 33 ] and are independent of weight gained during pregnancy and of GDM. Different studies [ 18 , 19 , 42 , 43 ] report an increased risk for obese women to have affected offspring. Rougée LR et al [ 44 ] concluded that maternal obesity was significantly associated with elevated neonatal unconjugated bilirubin levels. Furthermore, newborns in the obese group were 3.26 times more likely to be admitted to the NICU. Callaway LK et al, [ 45 ] in their study concluded that respiratory distress was not significantly different between the obese and non-obese group of mothers, while the need for mechanical ventilation increased significantly with increasing maternal BMI. A meta-analysis [ 46 ] concludes that unexplained foetal mortality is 50% higher in overweight patients and twice as frequent in those with obesity. Limitations A fundamental limitation of the study is that, despite the fact that the sample represents practically the entire population of Cantabria, it was not possible to collect the sample from Laredo Hospital or Mompía Hospital because the women's BMI was not recorded. It was not possible to collect the sample from Laredo Hospital or Mompía Hospital because the BMI of the women was not recorded, these being the other two hospitals in Cantabria where deliveries take place. In any case, Laredo Hospital had 257 deliveries in 2021 and 306 in 2022 and refers most of the obese pregnant women to the reference hospital, the Hospital Universitario Marqués de Valdecilla. Mompía Hospital had 198 deliveries per year in 2021 and 174 in 2022. While in the Marqués de Valdecilla University Hospital, there were 2768 deliveries in 2021, representing 85.88% of all deliveries in Cantabria, and 2679 deliveries in 2022, representing 84.80%. CONCLUSIONS Obesity in pregnancy is a conflict for public health because it increases obstetric and neonatal risks, [ 47 ] increases the risk of presenting diseases and complications during pregnancy and childbirth [ 48 ] and in the fetus the disorders include: Foetal macrosomia, respiratory distress syndrome, SGA foetuses, prematurity, genetic malformations and increased risk of foetal death.[ 49 ] Maternal obesity [ 46 ] contributes significantly to poorer outcomes for both mother and baby during labour and in the immediate postpartum period. National clinical guidelines for the management of obese pregnant women and public health interventions are urgently needed to protect the health of mothers and their babies. Funding Declaration. This study has not been funded. The authors declare that they have no conflict of interest. Abbreviations ANOVA: Analysis of Variance BMI: Body Mass Index GDM: Gestational Diabetes Mellitus HTN: Hypertension arterial NICU: Neonatal Intensive Care Unit SGA: Small for gestational age PIH: Gestational hypertension or pregnancy-induced hypertension RFWL: Risk of Foetal Well-being Loss Declarations This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Funding Declaration. This study has not been funded. The authors declare that they have no conflict of interest. AUTHOR CONTRIBUTION Study design: Alba DIEZ-IBARBIA, Juan Manuel ODRIOZOLA-FEU, Carmen SARABIA-COBO. Data collection: Alba DIEZ-IBARBIA. Data analysis: Alba DIEZ-IBARBIA, Carmen SARABIA-COBO. Study supervision: Carmen SARABIA-COBO, Juan Manuel ODRIOZOLA-FEU. Manuscript writing: Carmen SARABIA-COBO, Eva DIEZ-PAZ. Critical revisions for important intellectual content: Juan Manuel ODRIOZOLA-FEU, Carmen SARABIA-COBO. 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Dasgupta A, Harichandrakumar KT, Habeebullah S. Pregnancy Outcome among Obese Indians-A Prospective Cohort Study in a Tertiary Care Centre in South India. Int J Sci Study. 2014;2:13–8. Menon RM, Dgo MI. Impact of body index on pregnancy outcome: A prospective cohort study. Paripex Indian J Res. 2019;8(2):7–9. Manrique Camasca LV. Complicaciones obstétricas y perinatales en gestantes con sobrepeso y obesidad pregestacional atendidas en el hospital Rezola Cañete durante el año 2015. Universidad San Martín de Porres; 2016. Kim SY, Sharma AJ, Sappenfield W, Wilson HG, Salihu HM. Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births. Obstet Gynecol. 2014;123(4):737–44. 10.1097/AOG.0000000000000177 . Zhang C, Wu Y, Li S, Zhang D. Maternal prepregnancy obesity and the risk of shoulder dystocia: a meta-analysis. BJOG. 2018;125(4):407–13. 10.1111/1471-0528.14841 . Zhang J, Bricker L, Wray S, Quenby S. Poor uterine contractility in obese women. BJOG. 2007;114(3):343–8. 10.1111/j.1471-0528.2006.01233.x . Medero Canela R, Carrero Morera M, López Torres CR, Gil Barcenilla B. Prevalencia del exceso de peso en la gestación en Andalucía [Prevalence of excess weight in pregnancy in Andalusia]. Aten Primaria. 2021;53(5):102018. 10.1016/j.aprim.2021.102018 . Fagerberg MC, Maršál K, Källén K. Predicting the chance of vaginal delivery after one cesarean section: validation and elaboration of a published prediction model. Eur J Obstet Gynecol Reprod Biol. 2015;188:88–94. 10.1016/j.ejogrb.2015.02.031 . Kalok A, Zabil SA, Jamil MA, et al. Antenatal scoring system in predicting the success of planned vaginal birth following one previous caesarean section. J Obstet Gynaecol. 2018;38(3):339–43. 10.1080/01443615.2017.1355896 . Rogers AJG, Harper LM, Mari G. A conceptual framework for the impact of obesity on risk of cesarean delivery. Am J Obstet Gynecol. 2018;219(4):356–63. 10.1016/j.ajog.2018.06.006 . Piña Torres KT. Obesidad materna y complicaciones obstétricas. Hospital regional de Loreto. 2015–2016. Tesis de grado. Universidad Científica del Perú; 2018. Ducarme G, Rodrigues A, Aissaoui F, Davitian C. Grossesse des patientes obèses: quels risques faut-il craindre? Gynecol Obstet Amp Fertil. 2007;35(1):19–24. Fyfe EM, Thompson JM, Anderson NH, Groom KM, McCowan LM. Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study. BMC Pregnancy Childbirth. 2012;12:112. Published 2012 Oct 18. 10.1186/1471-2393-12-112 . McDonald SD, Han Z, Mulla S, Beyene J, Knowledge Synthesis Group. Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systematic review and meta-analyses. BMJ. 2010;341:c3428. 10.1136/bmj.c3428 . Published 2010 Jul 20. D'Souza R, Horyn I, Pavalagantharajah S, Zaffar N, Jacob CE. Maternal body mass index and pregnancy outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol MFM. 2019;1(4):100041. 10.1016/j.ajogmf.2019.100041 . Usha Kiran TS, Hemmadi S, Bethel J, Evans J. Outcome of pregnancy in a woman with an increased body mass index. BJOG. 2005;112(6):768–72. 10.1111/j.1471-0528.2004.00546.x . Prosego. Obesidad y embarazo. En: Medicina perinatal. Editorial desconocido; 2011. p. 21. Rodriguez Mantilla PP. Factores asociados a anemia en puerperas de parto vaginal atendidas en el Hospital de Apoyo Chepén. Tesis para obtener título profesional de Médico Cirujano. Universidad César Vallejo; 2023. Di Marco I, Flores L, Secondi M, Ramírez Almanza S, Naddeo S, Bustamante P. Obesidad en el Embarazo Manejo de la obesidad materna antes, durante y después de la gestación. Guía de Práctica Clínica. Editorial desconocido; 2011. Camacho Prieto KA, Torres Miranda NS, Guzmán Canabal CA, Ordosgoitia Betin ME. Relación entre la obesidad materna y los resultados perinatales: revisión sistemática y metaanálisis. RECIMUNDO [Internet]. 16jun.2023 [citado 2jun.2024];7(1):689 – 96. https://recimundo.com/index.php/es/article/view/2009 . Slack E, Best KE, Rankin J, Heslehurst N. Maternal obesity classes, preterm and post-term birth: a retrospective analysis of 479,864 births in England. BMC Pregnancy Childbirth. 2019;19(1):434. 10.1186/s12884-019-2585-z . Published 2019 Nov 21. Jorly M-M, Eduardo R-V. Obesidad, resistencia a la insulina e hipertensión durante el embarazo. Rdo. Venir Endocrinol. Metab. [Internet]. Octubre de 2017 [consultado el 2 de junio de 2024]; 15(3): 169–181. Disponible en: http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S1690-31102017000300002&lng=es . Rougée LR, Miyagi SJ, Collier AC. Obstetric Obesity is Associated with Neonatal Hyperbilirubinemia with High Prevalence in Native Hawaiians and Pacific Island Women. Hawaii J Med Public Health. 2016;75(12):373–8. Callaway LK, Prins JB, Chang AM, McIntyre HD. The prevalence and impact of overweight and obesity in an Australian obstetric population. Med J Aust. 2006;184(2):56–9. 10.5694/j.1326-5377.2006.tb00115.x . Heslehurst N, Simpson H, Ells LJ, et al. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev. 2008;9(6):635–83. 10.1111/j.1467-789X.2008.00511.x . Suárez González Juan Antonio. Preciado Guerrero Richard, Gutiérrez Machado Mario, Cabrera Delgado María Rosa, Marín Tápanes Yoani, Cairo González Vivian. Influencia de la obesidad pregestacional en el riesgo de preeclampsia/eclampsia. Rev Cubana Obstet Ginecol [Internet]. 2013 Mar [citado 2024 Jun 02]; 39(1):3–11. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138-600X2013000100002&lng=es . Mendoza L, Pérez B, Sánchez Bernal S. Estado nutricional de embarazadas en el último mes de gestación y su asociación con las antropométricas de sus recién nacidos. Pediatra. (Asunción) [Internet]. Agosto de 2010 [consultado el 2 de junio de 2024]; 37(2): 91–6. Disponible en: http://scielo.iics.una.py/scielo.php?script=sci_arttext &pid=S1683-98032010000200003&lng=en. Abraham Z-N, Rogelio B-P, Ruiz-Dorado Marco Antonio. Efecto de la ganancia de peso gestacional en la madre y el neonato. Salud pública Méx [revista en la Internet]. 2010 Jun [citado 2024 Jun 02]; 52(3): 220–5. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext &pid=S0036-36342010000300006&lng=es Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4691249","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":330232818,"identity":"3191c30d-f742-4aec-993f-ba22029fa469","order_by":0,"name":"Alba Díez-Ibarbia","email":"","orcid":"","institution":"Marqués de Valdecilla University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Alba","middleName":"","lastName":"Díez-Ibarbia","suffix":""},{"id":330232819,"identity":"7632a4a1-11cf-416a-a53c-7f8db8373814","order_by":1,"name":"Juan Manuel Odriozola-Feu","email":"","orcid":"","institution":"Marqués de Valdecilla University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Manuel","lastName":"Odriozola-Feu","suffix":""},{"id":330232820,"identity":"fdba71cb-ad47-4915-8cd6-426ba6e7c372","order_by":2,"name":"Eva Díez-Paz","email":"","orcid":"","institution":"Marqués de Valdecilla University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Eva","middleName":"","lastName":"Díez-Paz","suffix":""},{"id":330232821,"identity":"e2dde5cb-5db5-4f97-816b-ab962a986110","order_by":3,"name":"Carmen Sarabia-Cobo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIie2PPUsDMRyHf8dBboncGijqVwgUroNH76skFOLqpoODUIhTda34JeLiy1YIOMV2bcnSIt4uQlHEl+vgJLF0c8gz/x+e3x+IRP45BAIlkG6oqE0VwK4/y08fnszzLar80tbz+fFE3mTp4uUAZRVSmNsvZhcOcjhWHS7uvbzrk3ZrCCVPAgqHIn5LN184FEwQL42laFFYEarwvCb+Q6PaddmSic/xSknfKb6CwzhrKolGYhwtmNSjlUKayigJDWPTmswGmskrRw+5POu1jSXFHuW94C/5uSLTN11WOy67Xrwuu9tmYh89PeoGh/3Efg1eI0QikUjkT74By5dSxOrCCgcAAAAASUVORK5CYII=","orcid":"","institution":"University of Cantabria","correspondingAuthor":true,"prefix":"","firstName":"Carmen","middleName":"","lastName":"Sarabia-Cobo","suffix":""}],"badges":[],"createdAt":"2024-07-05 09:33:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4691249/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4691249/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":65066450,"identity":"1a098261-045f-4696-a2ca-4fb35b0c959c","added_by":"auto","created_at":"2024-09-23 09:02:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":603110,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4691249/v1/b3369004-a87e-40ec-b9f1-9cb08f18d8f2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eMaternal-Foetal Complications in Pregnant Women with Obesity: a predictive model\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAs a summary, it should be noted that in this study significant results were found in the sense that obese pregnant women have a higher risk of diseases during pregnancy, complications during childbirth and a significant increase in the frequency of all treatments during the postpartum compared to pregnancy.\u003c/p\u003e \u003cp\u003eObesity is a serious public health problem, refered to as the new non-communicable epidemic of the 21st century and defined by The Obesity Society as a disease that not only underlies major chronic diseases, but is also a severely debilitating condition in its own right.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] During pregnancy, maternal obesity emerges as a major risk factor. This period, characterised by transient physiological changes, becomes even more sensitive when combined with obesity, which may exacerbate risks for both mother and fetus.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eMaternal complications associated with obesity during pregnancy include pre-eclampsia, gestational diabetes, venous thromboembolism and postpartum haemorrhage.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] For the foetus, complications can range from heart defects to metabolic problems and even increase the risk of congenital anomalies and foetal death.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] In addition, children of obese women are at increased risk of obesity in childhood and adulthood [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and may be at increased risk of congenital anomalies and metabolic complications. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe COVID-19 pandemic has introduced additional challenges, affecting health systems and potentially altering obesity rates in pregnant women. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Understanding how the pandemic has affected the prevalence and management of obesity in this group is essential to tailor clinical interventions to meet the changing needs of these women. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTherefore, the aim of this study is to analyse the maternal and neonatal consequences and morbidities associated with maternal obesity in the community of Cantabria, northern Spain, during the post-pandemic period (2021\u0026ndash;2022). This knowledge will help health professionals to be aware of the risks associated with maternal obesity and to develop effective strategies to manage pregnancy in obese women, in order to reduce or prevent complications in both mother and child.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA retrospective observational descriptive study was conducted in 2021 and 2022 among pregnant women who gave birth at the Marqu\u0026eacute;s de Valdecilla University Hospital, a public hospital in northern Spain.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy subjects\u003c/h2\u003e \u003cp\u003eThe sample selected was all women who had given birth at the hospital and who had a body mass index (BMI) greater than or equal to 30 before pregnancy. STROBE's COREQ recommendations were followed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eInclusion criteria were women with a pre-pregnancy BMI greater than or equal to 30 (obesity) who gave birth in 2021 and 2022 at the Marqu\u0026eacute;s de Valdecilla University Hospital, Cantabria Health Service.\u003c/p\u003e \u003cp\u003eExclusion criteria were women who fulfilled the main condition of not being considered obese at the time of pre-pregnancy (BMI greater than or equal to 30) or whose BMI was not recorded in the Altamira computer programme (Electronic Health Record of the Cantabrian Health System).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cp\u003eGestational variables: Whether they had received any treatment during pregnancy and, if so, the most common treatments were examined, including anticoagulants, antihypertensives and insulin. Variables on any illness during pregnancy were also collected, looking at the most common conditions such as gestational hypertension (PIH), gestational diabetes mellitus (GDM), hypothyroidism and hyperthyroidism. With regard to ultrasound scans performed during pregnancy, the results of ultrasound pathologies, foetal growth abnormalities, mean foetal percentile and number of fetuses diagnosed were studied.\u003c/p\u003e \u003cp\u003eLabour: The type of delivery, vaginal or caesarean, was analysed. For vaginal deliveries, the prevalence of ectopic and instrumental deliveries and the reasons for dystocia were studied. For caesarean section, the reasons for caesarean section were examined, distinguishing between emergency caesarean section and planned caesarean section. Any complications during labour were also recorded in detail.\u003c/p\u003e \u003cp\u003ePostpartum: complications such as anaemia, pre-eclampsia, hypertensive disorders, infection, wound dehiscence or bleeding, urinary pathology, postpartum fever, sepsis and postpartum haemorrhage were studied. Treatment during this period was also analysed, the most common being anticoagulants and antihypertensives.\u003c/p\u003e \u003cp\u003eNeonatal variables: Whether they required admission to the neonatal intensive care unit (NICU) and, if so, the most common reasons, such as respiratory distress, prematurity, neonatal jaundice, low birth weight, hypoglycaemia, maternal admission to NICU, infection, hypotonia, and neonatal death.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Procedure\u003c/h2\u003e \u003cp\u003eData collection was carried out from February to May 2023 using the Altamira Software Program of the Cantabrian Health Service. All healthcare episodes recorded in the patients' medical records providing relevant information on the subject were systematically reviewed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e With regard to ethical considerations, authorisation has been obtained from the Research Ethics Committee of the Community of Cantabria (code: 2022.344 and date of approval: 16/12/2022), the Head of the Gynaecology Service and the Head of the Maternity Unit of the Marqu\u0026eacute;s de Valdecilla University Hospital for the collection of data relating to her pregnancy, delivery and postpartum history. The data will be processed in such a way as to guarantee the confidentiality of the data and information contained in the study, in accordance with current Spanish legislation. The regulations of the ethics committee of the Cantabrian Health Service as well as the regulations in Spain establish that the authorisation of the hospital and the ethics committee is required exclusively for the collection of clinical history data, given that the data accessed by the researcher are disaggregated when obtained from the computer system: they do not contain personal data and therefore authorisation cannot be requested, as they are collected retroactively. The researchers are responsible for ensuring that the data obtained cannot be used for other purposes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSPSS v.22 was used. A statistical significance level of α\u0026thinsp;=\u0026thinsp;0.05 was used to assess the importance of the differences observed and to determine whether the results were statistically significant. Appropriate statistical tests were used, such as Chi-square tests for categorical variables and Student's t-tests or analysis of variance (ANOVA) for continuous variables, as appropriate. Correlation studies between the variables as well as logistic regression modelling were carried out to determine possible predictive values.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 920 records meeting the criteria were collected, of which 479 were from 2021 and 439 from 2022. The total number of deliveries attended was 2,768 in 2021 and 2,679 in 2022, giving a total of 5,447 deliveries. Therefore, the percentage of pregnant women with obesity was 17.30% in 2021 and 16.38% in 2022.\u003c/p\u003e \u003cp\u003eA comparison of proportions test was performed to determine whether there were significant differences in the incidence of pregnancy-related morbidity, postpartum complications, and the need for NICU admission between 2021 and 2022. No significant differences were found in the incidence of diseases during pregnancy between 2021 and 2022 (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Similarly, no significant differences were observed in the prevalence of postpartum complications between the two years (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). However, a significant difference was found in the need for NICU admission between 2021 and 2022 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with a higher proportion of newborns admitted to the NICU in 2022.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eGestational stage\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the variables collected in relation to diseases presented during this period, pathologies detected by ultrasound and foetal growth abnormalities. The mean ultrasound percentile was 63 (SD: 28.23). The mean number of foetuses diagnosed by ultrasound was 1.028 (SD: 0.18).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVariables of the Gestational Stage (N\u0026thinsp;=\u0026thinsp;920).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eGestational Stage\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiseases during pregnancy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo diseases\u003c/p\u003e \u003cp\u003e37.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePIH\u003c/p\u003e \u003cp\u003e37.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGDM\u003c/p\u003e \u003cp\u003e10.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGestational hypothyroi dism\u003c/p\u003e \u003cp\u003e10.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGestational hyperthyroidism\u003c/p\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePathologies in Ultrasound\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo pathologies\u003c/p\u003e \u003cp\u003e88%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes, they had pathologies\u003c/p\u003e \u003cp\u003e11.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePlacental alteration 0.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFoetal static alteration 0,4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eT\u003c/b\u003e \u003cb\u003eFoetal Growth Abnormalities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo abnormalities\u003c/p\u003e \u003cp\u003e69.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMacrosomia\u003c/p\u003e \u003cp\u003e23.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntrauterine growth restriction\u003c/p\u003e \u003cp\u003e3.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSmall for gestational age\u003c/p\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eLabor\u003c/h2\u003e \u003cp\u003eA classification model was developed using gestational and labor variables to predict the type of delivery (eutocic, instrumental, or cesarean). The results of the model identified the following significant predictor variables: Diseases during pregnancy (p\u0026thinsp;=\u0026thinsp;.021); Complications during labor (p\u0026thinsp;=\u0026thinsp;.003), and reason for cesarean section (p\u0026thinsp;=\u0026thinsp;.012).\u003c/p\u003e \u003cp\u003eThe classification model suggests that diseases during pregnancy, especially Hypertension arterial (HTN), complications during labor (with hemorrhage as the main one), and the reason for cesarean section, Risk of Foetal Well-being Loss (RFWL), are significant predictors of the type of delivery.\u003c/p\u003e \u003cp\u003eA regression analysis was conducted using gestational and ultrasound variables to predict the mean foetal percentile. Significant predictor variables were: Diseases during pregnancy (β = \u0026minus;\u0026thinsp;.27, p\u0026thinsp;=\u0026thinsp;.004), Pathologies in ultrasound (β = \u0026minus;\u0026thinsp;.21, p\u0026thinsp;=\u0026thinsp;.019), Complications during labor (β = \u0026minus;\u0026thinsp;.19, p\u0026thinsp;=\u0026thinsp;.032).\u003c/p\u003e \u003cp\u003eAdjusted R^2\u0026thinsp;=\u0026thinsp;.362. The regression analysis suggests that diseases during pregnancy (especially HTN), pathologies in ultrasound (placental alteration), and complications during labor (hemorrhage) are significant predictors of the mean foetal percentile.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e lists the variables collected regarding the type of delivery, reasons for instrumentalized delivery, cesarean deliveries, and the reason and complications.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBirth variables (N\u0026thinsp;=\u0026thinsp;920).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eBIRTH\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEutocic\u003c/p\u003e \u003cp\u003e63.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInstrumental\u003c/p\u003e \u003cp\u003e7.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCesarean\u003c/p\u003e \u003cp\u003e29.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal vaginal delivery\u003c/p\u003e \u003cp\u003e70.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInstrumentalized delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMetal suction cup\u003c/p\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKiwi Suction Cup\u003c/p\u003e \u003cp\u003e3.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eForceps\u003c/p\u003e \u003cp\u003e0.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReasons for instrumentalized delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFWL\u003c/p\u003e \u003cp\u003e47.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStationary delivery\u003c/p\u003e \u003cp\u003e49.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInduction failure\u003c/p\u003e \u003cp\u003e1.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCesarean deliveries\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrgent\u003c/p\u003e \u003cp\u003e20.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProgrammed\u003c/p\u003e \u003cp\u003e8.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReason cesarean deliveries\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRFWL\u003c/p\u003e \u003cp\u003e27.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStationary delivery\u003c/p\u003e \u003cp\u003e14.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInduction failure\u003c/p\u003e \u003cp\u003e18.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCephalopelvic disproportion\u003c/p\u003e \u003cp\u003e14.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eButtocks\u003c/p\u003e \u003cp\u003e19.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e87.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003e12.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePostpartum hemorrhage\u003c/p\u003e \u003cp\u003e4.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHypertensive state\u003c/p\u003e \u003cp\u003e0.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003cp\u003e6.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePostpartum\u003c/h2\u003e \u003cp\u003ePostpartum complications 61.2% had some type of pathology compared with 38.8% of women who had no postpartum complications. Of the women with postpartum complications, most had anaemia (82.8%). About 35.5% had pre-eclampsia and 27.4% had HTN. Regarding the Caesarean wound, 13.1% had infection, 6.3% had dehiscence and 1.4% had bleeding from the incision. Eight per cent had some type of urinary pathology, mainly infection or urinary retention. Among obese postpartum women, 7.3% had puerperal fever, 1.7% had sepsis, 1.2% had severe puerperal haemorrhage and 15.6% had other pathologies.\u003c/p\u003e \u003cp\u003eLogistic regression analysis was performed to determine whether there was a significant association between antenatal conditions and postpartum complications. A significant association was found between the presence of gestational disorders (such as PIH, GDM and anaemia) and the likelihood of complications in the puerperium (F(1,92)\u0026thinsp;=\u0026thinsp;13.25, p\u0026thinsp;=\u0026thinsp;.02). For example, women with PIH had an increased risk of developing pre-eclampsia during the puerperium (up to 2 times higher). A multinomial logistic regression model was run to see if ultrasound pathologies had any effect on the mode of delivery. We found that ultrasound pathologies (such as foetal growth abnormalities) were significantly associated with the type of delivery (ectopic, instrumental or caesarean) (F (1,92)\u0026thinsp;=\u0026thinsp;21.57, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). For example, fetuses diagnosed with macrosomia (weight greater than 4000 grams) were more likely to be delivered by caesarean section (up to 0.9 times more likely) than fetuses without foetal growth restriction. A logistic regression model was constructed using the presence of complications during the puerperium as the dependent variable and the predictor variables mentioned above. The results of the model were the following significant predictor variables: Presence of illness during gestation (β\u0026thinsp;=\u0026thinsp;1.25, p\u0026thinsp;\u0026lt;\u0026thinsp;.001); Type of delivery (β\u0026thinsp;=\u0026thinsp;.87, p\u0026thinsp;=\u0026thinsp;.003); Pathologies on ultrasound (β\u0026thinsp;=\u0026thinsp;0.94, p\u0026thinsp;=\u0026thinsp;.002) and complications during labour (β\u0026thinsp;=\u0026thinsp;1.10, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Adjusted R^2\u0026thinsp;=\u0026thinsp;.421 (indicating that the model explains 42.1% of the variability in the presence of complications during the puerperium). The corrected logistic regression model suggests that the presence of gestational disease (especially HTN) and complications during labour (notably haemorrhage) are the strongest predictors of postpartum complications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eMedication\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the most frequent pharmacological treatments both during pregnancy and postpartum. The most frequent were anticoagulants, iron, antihypertensives and insulin. In the postpartum period all treatments increased markedly, especially anticoagulants and iron, which more than doubled.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePharmacological treatment in pregnancy and puerperium (N\u0026thinsp;=\u0026thinsp;920).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTreatment during gestation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTreatment during puerperium\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHas taken any treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnticoagulant\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIron\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAntihypertensive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsulin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSignificant differences were found in the frequency of drug treatments (anticoagulants, iron, antihypertensives and insulin) between gestation and puerperium (F (1,36)\u0026thinsp;=\u0026thinsp;11.32, p\u0026thinsp;=\u0026thinsp;.03). Specifically, a significant increase in the frequency of all treatments was observed during the puerperium compared to gestation (p\u0026thinsp;=\u0026thinsp;.032).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eNewborn\u003c/h2\u003e \u003cp\u003eAfter birth in the delivery room, the immediate puerperium lasted approximately one and a half hours, during which time the vast majority of newborns did not require admission to the NICU in 91.8% of cases, and 8.2% required admission to the NICU. Once this period had elapsed and the mother and newborn were transferred to the maternity ward, 11.8% of newborns were admitted to the NICU and 88.2% did not require admission.\u003c/p\u003e \u003cp\u003eRegarding the reasons for admission of newborns to the intensive care unit, the most frequent was respiratory distress in 22.1% of the babies, followed by 15% for prematurity, and neonatal jaundice in 12.4%. Also, 11.5% of babies born to obese mothers were admitted for low neonatal weight, 9.7% for hypoglycaemia, 8.8% because the mother had to be admitted to the intensive care unit, 3.5% for hypotonia, 1.8% for infection and 13.3% for other types of reasons. Neonatal death occurred in 1.8% of infants born to obese mothers.\u003c/p\u003e \u003cp\u003eA logistic regression analysis was performed to investigate whether maternal obesity has any significant impact on the need for NICU admission and reasons for admission. Maternal obesity was found to be significantly associated with the need for NICU admission (F (1,69)\u0026thinsp;=\u0026thinsp;28.21, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). In addition, infants born to obese mothers were found to be at increased risk of NICU admission due to conditions such as respiratory distress and prematurity (up to 1.2 times higher).\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eWe will make a comparative study of the results of the variables both in gestation, labour and puerperium of the present study with those of other authors.\u003c/p\u003e \u003cp\u003eThe results of the gestational pathologies examined in our study show that only 37.8% had no pathology. The main pathologies were PIH, GDM, gestational hypothyroidism and gestational hyperthyroidism. The literature found [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] all point in the same direction: obese pregnant women have a significantly higher risk of obstetric complications than pregnant women with a normal BMI. These articles report that in terms of maternal complications, the risk of developing PIH, GDM, pre-eclampsia, hypothyroidism, hyperthyroidism, post-term pregnancy, caesarean section, preterm birth, post-partum haemorrhage, pelvic infection, urinary tract infection and macrosomia. Studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] mainly conclude an increased risk of developing GDM and PIH in overweight or obese pregnant women. In addition, Manrique Camasca LV [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] found that urinary tract infection was the most common obstetric complication, followed by anaemia and pre-eclampsia. Regarding ultrasound during pregnancy, in our study, 88% of ultrasounds performed during pregnancy showed no pathology, and the most common changes found were in the placenta and foetal statics. In our study, 23.8% of the foetal growth abnormalities were diagnosed as macrosomic foetuses, 3.6% as foetal growth restriction foetuses and 1.9% as Small for gestational age foetuses (SGA). The articles studied show that foetal weight was higher in overweight and obese pregnant women than in normal weight women. Foetal macrosomia, defined as was more frequent in overweight and obese pregnant women compared to normal weight pregnant women.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] A higher incidence of foetal macrosomia is observed in obese pregnant women.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] A relationship with shoulder dystocia has also been found.[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe results of the variables relating to labour show that in our study most women had a vaginal delivery, the majority of which were ectopic vaginal deliveries. Caesarean section was 29.3%. Regarding vaginal delivery, in our study, the majority of reasons for instrumental delivery were due to induction failure, RFWL and induction failure. Evidence [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] suggests that there appears to be evidence of reduced uterine contractility in obese pregnant women compared to normal weight pregnant women. In the study by Medero Canela et al [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] carried out in Andalusia on obese pregnant women, the mode of delivery was mainly vaginal in 71.5% compared with 28.6% that ended in caesarean section. The complications that led to instrumental deliveries were mainly obstructed labour (49.2%) and foetal distress (47.5%). In the study by Kutchi et al [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] obese women were 4.69 times more likely to experience prolonged labour. In this study, instrumental deliveries were more common in non-obese subjects, although not statistically significant, while most researchers, [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] found an increased risk of operative vaginal deliveries in obese subjects. BMI at the end of pregnancy was lower in women with successful vaginal delivery, as in most studies. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] This means that the higher the maternal weight, the lower the probability of vaginal delivery. Regarding caesarean delivery, in our study, the main reason for indicating caesarean delivery is for RFWL, followed by mal breech position, induction failure, stationary delivery and Cephalopelvic disproportion. Most of the articles found are along the same lines. In particular, obesity is a significant risk for both planned and emergency caesarean deliveries [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Studies have consistently shown higher rates of caesarean section in obese women compared to those with a normal BMI. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] In relation to the type of delivery, several studies conducted in Spain and other countries [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] show an increased risk of instrumental deliveries and caesarean sections in overweight and obese pregnant women compared to those of normal weight, which increases as the BMI increases.\u003c/p\u003e \u003cp\u003eIn terms of complications during labour, our article details that the majority of women did not have any type of complication, compared to 12.2% who had complications during this process. The most common complications were postpartum haemorrhage and hypertensive disorders. In the study by Kutchi et al [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] postpartum haemorrhage was found to be 2.21 times more common in obese subjects, while the risk of pre-eclampsia increased 9.2 times.[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] Concluded in their study that obese nulliparous women have twice the risk of major postpartum haemorrhage, regardless of the mode of delivery. The increased postpartum haemorrhage may be due to a larger placental implantation surface area or a large volume of distribution and reduced bioavailability of uterotonic agents. A systematic review [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] concluded that overweight or obese mothers have a higher risk of preterm birth than mothers with a normal BMI. Obese pregnant women [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] are at increased risk of a range of maternal and perinatal complications, and this risk increases with the degree of obesity.\u003c/p\u003e \u003cp\u003eObesity in the postpartum period has short and long-term consequences for both the mother and the newborn. The following are the results found in the different studies: Regarding maternal complications in the postpartum period in our study, as detailed in the results, 61.2% had some type of pathology. Among these, a significant association was found between the presence of gestational disorders (such as PIH, GDM and anaemia) and the likelihood of having complications in the puerperium. With regard to the caesarean wound, the main complications were infection and dehiscence. It should also be noted that all treatments increased dramatically in the postpartum period, especially anticoagulant treatments and iron, which more than doubled.\u003c/p\u003e \u003cp\u003eSeveral articles deal with this issue and find similar results. In the study by Medero Canela et al [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] in the postpartum period, 2.6% had wound infection, 1.6% haemorrhage and 0.7% suture dehiscence. In the study of the Hospital de Loreto, [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] 46.2% of pregnant women with grade I obesity presented some obstetric complication. The most frequent complications were urinary tract infection (40.4%), caesarean section (38.5%), anaemia (23.1%), perineal tear (19.2%), PIH (13.5%) and pre-eclampsia (13.5%). In other studies, [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] showed that postpartum haemorrhage is more frequent in obese women. In the \"Obstetric care protocol on obesity and pregnancy\" by the S.E.G.O.[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] the main causes of maternal mortality, such as pre-eclampsia, postpartum haemorrhage and obstructed labour are significantly increased by obesity. Therefore, there is an indirect influence between obesity and maternal or foetal mortality. In the study by Rodriguez Mantilla [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] one of the factors that was not associated with anaemia in postpartum women was gestational obesity. In the study by Kutchi et al, [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] the risk of GDM was 4.85 times higher among obese pregnant women with 12.46 times higher risk of requiring insulin. The postpartum period,[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] remains a high-risk period for obese women (endomyometritis, wall infection and thromboembolism). Universal assessment of thrombotic risk in the immediate postpartum period should be performed in all pregnant women.\u003c/p\u003e \u003cp\u003eRegarding neonatal complications, our study found that maternal obesity is significantly associated with the need for NICU admission. In addition, neonates born to obese mothers were found to have an increased risk of NICU admission due to conditions such as respiratory distress and prematurity (up to 1.2 times higher). Much of the literature reviewed shows that infants born to obese mothers require more admissions to the neonatal unit and therefore more associated complications. Based on the literature consulted\u003csup\u003e41\u003c/sup\u003e there is no doubt that there is a positive relationship between maternal obesity and perinatal outcomes, which put not only the life of the pregnant woman at risk but also the development of the foetus and neonate at birth. The meta-analysis of Camacho Prieto et al, [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] demonstrated an increase in foetal weight and foetal macrosomia in overweight and obese pregnant women. The risk of foetal macrosomia increases with BMI. These same results have been corroborated by other authors [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and are independent of weight gained during pregnancy and of GDM. Different studies [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] report an increased risk for obese women to have affected offspring. Roug\u0026eacute;e LR et al [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] concluded that maternal obesity was significantly associated with elevated neonatal unconjugated bilirubin levels. Furthermore, newborns in the obese group were 3.26 times more likely to be admitted to the NICU. Callaway LK et al, [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] in their study concluded that respiratory distress was not significantly different between the obese and non-obese group of mothers, while the need for mechanical ventilation increased significantly with increasing maternal BMI. A meta-analysis [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] concludes that unexplained foetal mortality is 50% higher in overweight patients and twice as frequent in those with obesity.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eA fundamental limitation of the study is that, despite the fact that the sample represents practically the entire population of Cantabria, it was not possible to collect the sample from Laredo Hospital or Momp\u0026iacute;a Hospital because the women's BMI was not recorded. It was not possible to collect the sample from Laredo Hospital or Momp\u0026iacute;a Hospital because the BMI of the women was not recorded, these being the other two hospitals in Cantabria where deliveries take place. In any case, Laredo Hospital had 257 deliveries in 2021 and 306 in 2022 and refers most of the obese pregnant women to the reference hospital, the Hospital Universitario Marqu\u0026eacute;s de Valdecilla. Momp\u0026iacute;a Hospital had 198 deliveries per year in 2021 and 174 in 2022. While in the Marqu\u0026eacute;s de Valdecilla University Hospital, there were 2768 deliveries in 2021, representing 85.88% of all deliveries in Cantabria, and 2679 deliveries in 2022, representing 84.80%.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eObesity in pregnancy is a conflict for public health because it increases obstetric and neonatal risks, [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e] increases the risk of presenting diseases and complications during pregnancy and childbirth [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e] and in the fetus the disorders include: Foetal macrosomia, respiratory distress syndrome, SGA foetuses, prematurity, genetic malformations and increased risk of foetal death.[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e] Maternal obesity [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] contributes significantly to poorer outcomes for both mother and baby during labour and in the immediate postpartum period. National clinical guidelines for the management of obese pregnant women and public health interventions are urgently needed to protect the health of mothers and their babies.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFunding Declaration. This study has not been funded.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eThe authors declare that they have no conflict of interest.\u003c/b\u003e \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANOVA: Analysis of Variance\u003c/p\u003e\n\u003cp\u003eBMI: Body Mass Index\u003c/p\u003e\n\u003cp\u003eGDM: Gestational Diabetes Mellitus\u003c/p\u003e\n\u003cp\u003eHTN: Hypertension arterial\u003c/p\u003e\n\u003cp\u003eNICU: Neonatal Intensive Care Unit\u003c/p\u003e\n\u003cp\u003eSGA: Small for gestational age\u003c/p\u003e\n\u003cp\u003ePIH: Gestational hypertension or pregnancy-induced hypertension\u003c/p\u003e\n\u003cp\u003eRFWL: Risk of Foetal Well-being Loss\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration. This study has not been funded.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe authors declare that they have no conflict of interest.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design: Alba DIEZ-IBARBIA, Juan Manuel ODRIOZOLA-FEU, Carmen SARABIA-COBO.\u003c/p\u003e\n\u003cp\u003eData collection: Alba DIEZ-IBARBIA.\u003c/p\u003e\n\u003cp\u003eData analysis: Alba DIEZ-IBARBIA, Carmen SARABIA-COBO.\u003c/p\u003e\n\u003cp\u003eStudy supervision: Carmen SARABIA-COBO, Juan Manuel ODRIOZOLA-FEU.\u003c/p\u003e\n\u003cp\u003eManuscript writing: Carmen SARABIA-COBO, Eva DIEZ-PAZ.\u003c/p\u003e\n\u003cp\u003eCritical revisions for important intellectual content: Juan Manuel ODRIOZOLA-FEU, Carmen SARABIA-COBO.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJastreboff AM, Kotz CM, Kahan S, Kelly AS, Heymsfield SB. 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Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.scielo.org.mx/scielo.php?script=sci_arttext\u003c/span\u003e\u003cspan address=\"http://www.scielo.org.mx/scielo.php?script=sci_arttext\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u0026amp;pid=S0036-36342010000300006\u0026amp;lng=es\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pregnant women, Maternal obesity, Obstetric complications, Maternal morbidity, Neonatal morbidity","lastPublishedDoi":"10.21203/rs.3.rs-4691249/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4691249/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eObesity is a recognised global epidemic with serious consequences, including increased risk of morbidity and reduced life expectancy. It is a chronic, multifactorial disease defined by a Body Mass Index\u0026thinsp;\u0026ge;\u0026thinsp;30 kg/m\u003csup\u003e2\u003c/sup\u003e. It also imposes a significant economic burden on individuals, families and countries. During pregnancy, maternal obesity is a significant risk factor, making pregnancy a vulnerable period for obese women, potentially worsening its course and having adverse effects on both mother and foetus. In addition, the offspring of obese pregnant women are at increased risk of obesity in childhood and adulthood. Therefore, the aim of this study was to describe the maternal and neonatal consequences and morbidity associated with maternal obesity in pregnant women in the community of Cantabria, northern Spain, in the post-pandemic era.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was achieved through a retrospective observational descriptive study of pregnant women who gave birth at the Marqu\u0026eacute;s de Valdecilla University Hospital in Cantabria during the years 2021 and 2022. STROBE's COREQ recommendations were followed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eNo significant differences were found in the incidence of diseases during pregnancy and postpartum between 2021 and 2022. However, a significant difference was found in the need for Neonatal Intensive Care Unit admission, with a higher proportion of newborns admitted to the Neonatal Intensive Care Unit in 2022. The classification model suggests that diseases during pregnancy, especially Hypertension arterial, complications during labor (with hemorrhage as the main one), and the reason for cesarean section, Risk of Foetal Well-being Loss, are significant predictors of the type of delivery. A significant increase in the frequency of all treatments was observed during the puerperium compared to gestation.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eObesity increases the risk of presenting diseases and complications during pregnancy, childbirth and neonatal risks. Therefore the pregnancy is a conflict for public health because it increases obstetric.\u003c/p\u003e","manuscriptTitle":"Maternal-Foetal Complications in Pregnant Women with Obesity: a predictive model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-08 10:54:04","doi":"10.21203/rs.3.rs-4691249/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"764d5c04-98da-40e2-8734-dedf95b9b0a9","owner":[],"postedDate":"August 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-23T08:54:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-08 10:54:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4691249","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4691249","identity":"rs-4691249","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}