PREGNANCY OUTCOME AND WEIGHT-GAIN RECOMMENDATIONS FOR THE MORBIDLY OBESE WOMAN

Objective: To compare pregnancy outcomes between morbidly obese and no nobese women and to determine the effect of gestational weight gain on pregnancy outcome in morbidly obese women. Methods: A retrospective c ohort study was conducted comparing 613 morbidly obese and 11,313 nono bese women who were delivered of a singleton live birth. Morbid obesit y was defined as a body mass index greater than 35. The incidence of s elected perinatal and neonatal outcomes was assessed for the two group s. Multiple logistic regression analysis was used to evaluate the asso ciation between morbid obesity and various measures of outcome while c ontrolling for potential confounders. A subanalysis of the morbidly ob ese patients was performed to assess the effect of gestational weight gain on pregnancy outcome. Results: Morbidly obese patients were more likely to experience pregnancy complications including diabetes, hyper tension, preeclampsia, and arrest-of-labor disorders; however, these w ere not affected by gestational weight gain. Morbidly obese patients w ere more likely to experience fetal distress and meconium and to under go cesarean delivery than their nonobese counterparts (P < .05). Weigh t gains of more than 25 lb were associated strongly with birth of a la rge for gestational age (LGA) neonate (P < .01); however, poor weight gain did not appear to increase the risk of delivery of a low birth we ight neonate. Conclusion: Gestational weight gain was not associated w ith adverse perinatal outcome, but it did influence neonatal outcome. To reduce the risk of delivery of an LGA newborn, the optimal gestatio nal weight gain for morbidly obese women should not exceed 25 lb.