A Comparative Study of Maternal and Neonatal Outcomes in Obese and Non-obese Iraqi Pregnant Women Undergoing Cesarean Section.

backgroundObesity has become a global health concern, and it is on the rise in developed nations among both the general and the obstetric populations. To know if a person has obesity or normal body weight, the body mass index (BMI) is now widely used and regarded as a trustworthy indicator.

aimThis study was designed to compare maternal and neonatal outcomes between obese and non-obese pregnant women who underwent cesarean section (C/S) in Basra city in the south of Iraq.

methodThis comparative observational cross-sectional study was done in Basra Teaching Hospital, Basra, Iraq, from May 10, 2024, to November 10, 2024, on 206 pregnant women aged between 15 and 50 years old who underwent C/S delivery. The participants were subdivided into three groups according to their BMI: group one: normal weight (n = 64) with a BMI of 18.5-24.9 kg/m², group two: overweight (n = 79) with a BMI of 25-29.9 kg/m², and group three: obese (n = 63) with a BMI of ≥30 kg/m². A study of their preoperative data, including age, blood pressure, BMI, educational level, occupation, gestational hypertension, gestational diabetes mellitus (GDM), previous abortion, previous stillbirth, parity, number of previous C/S, and gestational age, and correlations with their postoperative findings; postpartum hemorrhage (PPH), the time of initial mobility from bed after surgery, the time of starting breastfeeding, the time of starting intestinal sounds, macrosomia, and admission of neonates to the intensive care unit (NICU) was recorded, analyzed, and compared for all three groups. The statistical significance level is considered the p-value < 0.05.

resultsThe results demonstrated a clear correlation between maternal and neonatal complications following C/Ss and increased BMI. High BMI was substantially related to maternal factors that differed considerably across the groups, including education level (p-value = 0.001), parity (p-value ≤ 0.001), and the number of previous C/S (p-value = 0.011). Prenatal problems such as GDM (p-value = 0.042) and gestational hypertension (p-value = 0.016) also showed a significant difference, with the obese group experiencing greater rates than the overweight and normal groups. The results showed that there was a significant difference related to maternal postoperative outcomes like the initial time of returning intestinal sounds (p-value = 0.026), the initial time of starting mobility (p-value ≤ 0.001), and the initial time of starting breastfeeding (p-value ≤ 0.001), as well as neonatal postoperative outcomes like macrosomia (p-value = 0.030) and neonatal admission to the NICU (p-value = 0.001); they were also higher in the obese group. Also, the obese group has a longer duration of surgery (p-value ≤ 0.001) and hospital stay (p-value ≤ 0.001) than the other groups. The results showed a non-significant difference regarding PPH among the study groups.

conclusionThe study concluded that obesity has adverse effects on pregnancy outcomes for mothers and their infants. A low educational level is associated with high BMI, leading to high risks of postoperative complications. Gestational diabetes and gestational hypertension are more frequent in obese women. Obese women should be considered high-risk and recommended to maintain weight to reduce any complications after surgery.