Association Between Gestational Weight Gain and Obstetric Anal Sphincter Injury.

Sahar Khademioore, Sara Khademioureh, Ahmad Sofi-Mahmudi, Roxana Geoffrion, Rohan D'Souza, Giulia M Muraca

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Article in O&G open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

6 authors.

Sahar KhademiooreDepartment of Health Research Methods, Evidence, and Impact, and the Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, the School of Public Health, University of Alberta, Edmonton, Alberta, and the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and the Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.

Sara KhademiourehDepartment of Health Research Methods, Evidence, and Impact, and the Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, the School of Public Health, University of Alberta, Edmonton, Alberta, and the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and the Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.

Ahmad Sofi-MahmudiDepartment of Health Research Methods, Evidence, and Impact, and the Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, the School of Public Health, University of Alberta, Edmonton, Alberta, and the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and the Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.

Roxana GeoffrionDepartment of Health Research Methods, Evidence, and Impact, and the Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, the School of Public Health, University of Alberta, Edmonton, Alberta, and the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and the Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.

Rohan D'SouzaDepartment of Health Research Methods, Evidence, and Impact, and the Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, the School of Public Health, University of Alberta, Edmonton, Alberta, and the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and the Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.

Giulia M MuracaDepartment of Health Research Methods, Evidence, and Impact, and the Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, the School of Public Health, University of Alberta, Edmonton, Alberta, and the Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and the Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo investigate the association between gestational weight gain across all prepregnancy body mass index (BMI) categories and the risk of obstetric anal sphincter injury during vaginal birth.

methodsOur retrospective population-based cohort study included individuals with singleton, term, vaginal births in the United States (2021-2023) and used data from the National Vital Statistics System's natality files. We examined the association between gestational weight gain (below, within, or above Institute of Medicine guidelines) and obstetric anal sphincter injury across BMI categories using logistic regression models. We assessed nonlinear associations between gestational weight gain and obstetric anal sphincter injury using restricted cubic spline regression and conducted a mediation analysis to examine the influence of fetal birth weight.

resultsObstetric anal sphincter injury occurred in 1.2% of births, with rates of 1.3% among those who gained above the recommendations, 1.2% among those who gained within the recommendations, and 1.0% among those who gained below the recommendations. Gestational weight gain above and within guideline recommendations were associated with increased odds of obstetric anal sphincter injury among individuals with average-weight (adjusted odds ratio [aOR] 1.08; 95% CI, 1.05-1.10), overweight (aOR 1.13; 95% CI, 1.09-1.17), class I obesity (aOR 1.12; 95% CI, 1.06-1.18), and class II obesity (aOR 1.15; 95% CI, 1.06-1.26) BMIs. Gestational weight gain below and within recommendations showed a protective effect against obstetric anal sphincter injury only in individuals with average-weight BMIs (aOR 0.91; 95% CI, 0.88-0.93). Mediation analyses showed that gestational weight gain indirectly affected obstetric anal sphincter injury risk through birth weight across all BMI groups; direct effects were observed only in individuals with underweight, average-weight, and overweight BMIs.

conclusionGestational weight gain above the Institute of Medicine guideline was associated with increased risk of obstetric anal sphincter injury across all BMI categories except for underweight and class III obesity; weight gain below the guideline appeared to be protective only at average weight. These associations were largely mediated through birth weight.

Identifiers

PMID41080918

DOI10.1097/og9.0000000000000117

PMCPMC12510150

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