Maternal Body Mass Index and Regional Anaesthesia Use at Term: Prevalence and Complications

Research output: Contribution to journalArticle

  • 1 Citations

Abstract

Background: There is an evidence gap regarding the use of regional anaesthesia (epidural, spinal, or combined epidural/spinal anaesthesia) and associated complications by maternal body mass index (BMI). We examine associations between regional anaesthesia, mode of delivery, and regional anaesthesia complications by pre-pregnancy BMI categories among term deliveries. Methods: Retrospective cohort study of births in California, 2007-2010, utilizing linked birth certificate data and patient discharge data. Outcomes were mode of delivery (among laboured deliveries) and select regional anaesthesia complications. Multivariable Poisson regression was used to adjust for maternal characteristics. Results: In women undergoing labour (i.e. laboured delivery), women with higher BMI categories were more likely to receive regional analgesia in a dose–response fashion (adjusted risk ratio [RR] 1.10, 95% confidence interval [CI] 1.10, 1.11 for primiparous women with category I obesity), and in those receiving regional anaesthesia, were less likely to deliver vaginally (e.g. RR 0.85, 95% CI 0.84, 0.85 for the same category of women). Regional anaesthesia complications displayed a complex relationship with maternal BMI, with women in intermediate obesity categories having decreased odds as compared to normal-weight women, and women in the highest BMI category having a twofold increased risk of complications (RR 2.34, 95% CI 1.37, 4.02 for primiparous women). Conclusion: Labouring women in higher BMI categories were more likely to receive regional anaesthesia and more likely to deliver via caesarean compared to normal weight women and women without regional anaesthesia. Rates of anaesthesia complications were highest among women in the highest BMI category.

LanguageEnglish (US)
Pages495-505
Number of pages11
JournalPaediatric and Perinatal Epidemiology
Volume31
Issue number6
DOIs
StatePublished - Nov 1 2017

Fingerprint

Conduction Anesthesia
Body Mass Index
Mothers
Odds Ratio
Confidence Intervals
Obesity
Birth Certificates
Weights and Measures
Pregnancy Complications
Patient Discharge
Epidural Anesthesia
Spinal Anesthesia
Analgesia
Cohort Studies
Anesthesia
Retrospective Studies
Parturition

Keywords

  • BMI
  • caesarean delivery
  • labour
  • regional anaesthesia

ASJC Scopus subject areas

  • Epidemiology
  • Pediatrics, Perinatology, and Child Health

Cite this

Maternal Body Mass Index and Regional Anaesthesia Use at Term : Prevalence and Complications. / Biel, Frances M.; Marshall, Nicole E.; Snowden, Jonathan M.

In: Paediatric and Perinatal Epidemiology, Vol. 31, No. 6, 01.11.2017, p. 495-505.

Research output: Contribution to journalArticle

@article{4135ec8d83e8445a87b0d07cd2ef34f4,
title = "Maternal Body Mass Index and Regional Anaesthesia Use at Term: Prevalence and Complications",
abstract = "Background: There is an evidence gap regarding the use of regional anaesthesia (epidural, spinal, or combined epidural/spinal anaesthesia) and associated complications by maternal body mass index (BMI). We examine associations between regional anaesthesia, mode of delivery, and regional anaesthesia complications by pre-pregnancy BMI categories among term deliveries. Methods: Retrospective cohort study of births in California, 2007-2010, utilizing linked birth certificate data and patient discharge data. Outcomes were mode of delivery (among laboured deliveries) and select regional anaesthesia complications. Multivariable Poisson regression was used to adjust for maternal characteristics. Results: In women undergoing labour (i.e. laboured delivery), women with higher BMI categories were more likely to receive regional analgesia in a dose–response fashion (adjusted risk ratio [RR] 1.10, 95{\%} confidence interval [CI] 1.10, 1.11 for primiparous women with category I obesity), and in those receiving regional anaesthesia, were less likely to deliver vaginally (e.g. RR 0.85, 95{\%} CI 0.84, 0.85 for the same category of women). Regional anaesthesia complications displayed a complex relationship with maternal BMI, with women in intermediate obesity categories having decreased odds as compared to normal-weight women, and women in the highest BMI category having a twofold increased risk of complications (RR 2.34, 95{\%} CI 1.37, 4.02 for primiparous women). Conclusion: Labouring women in higher BMI categories were more likely to receive regional anaesthesia and more likely to deliver via caesarean compared to normal weight women and women without regional anaesthesia. Rates of anaesthesia complications were highest among women in the highest BMI category.",
keywords = "BMI, caesarean delivery, labour, regional anaesthesia",
author = "Biel, {Frances M.} and Marshall, {Nicole E.} and Snowden, {Jonathan M.}",
year = "2017",
month = "11",
day = "1",
doi = "10.1111/ppe.12387",
language = "English (US)",
volume = "31",
pages = "495--505",
journal = "Paediatric and Perinatal Epidemiology",
issn = "0269-5022",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Maternal Body Mass Index and Regional Anaesthesia Use at Term

T2 - Paediatric and Perinatal Epidemiology

AU - Biel,Frances M.

AU - Marshall,Nicole E.

AU - Snowden,Jonathan M.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background: There is an evidence gap regarding the use of regional anaesthesia (epidural, spinal, or combined epidural/spinal anaesthesia) and associated complications by maternal body mass index (BMI). We examine associations between regional anaesthesia, mode of delivery, and regional anaesthesia complications by pre-pregnancy BMI categories among term deliveries. Methods: Retrospective cohort study of births in California, 2007-2010, utilizing linked birth certificate data and patient discharge data. Outcomes were mode of delivery (among laboured deliveries) and select regional anaesthesia complications. Multivariable Poisson regression was used to adjust for maternal characteristics. Results: In women undergoing labour (i.e. laboured delivery), women with higher BMI categories were more likely to receive regional analgesia in a dose–response fashion (adjusted risk ratio [RR] 1.10, 95% confidence interval [CI] 1.10, 1.11 for primiparous women with category I obesity), and in those receiving regional anaesthesia, were less likely to deliver vaginally (e.g. RR 0.85, 95% CI 0.84, 0.85 for the same category of women). Regional anaesthesia complications displayed a complex relationship with maternal BMI, with women in intermediate obesity categories having decreased odds as compared to normal-weight women, and women in the highest BMI category having a twofold increased risk of complications (RR 2.34, 95% CI 1.37, 4.02 for primiparous women). Conclusion: Labouring women in higher BMI categories were more likely to receive regional anaesthesia and more likely to deliver via caesarean compared to normal weight women and women without regional anaesthesia. Rates of anaesthesia complications were highest among women in the highest BMI category.

AB - Background: There is an evidence gap regarding the use of regional anaesthesia (epidural, spinal, or combined epidural/spinal anaesthesia) and associated complications by maternal body mass index (BMI). We examine associations between regional anaesthesia, mode of delivery, and regional anaesthesia complications by pre-pregnancy BMI categories among term deliveries. Methods: Retrospective cohort study of births in California, 2007-2010, utilizing linked birth certificate data and patient discharge data. Outcomes were mode of delivery (among laboured deliveries) and select regional anaesthesia complications. Multivariable Poisson regression was used to adjust for maternal characteristics. Results: In women undergoing labour (i.e. laboured delivery), women with higher BMI categories were more likely to receive regional analgesia in a dose–response fashion (adjusted risk ratio [RR] 1.10, 95% confidence interval [CI] 1.10, 1.11 for primiparous women with category I obesity), and in those receiving regional anaesthesia, were less likely to deliver vaginally (e.g. RR 0.85, 95% CI 0.84, 0.85 for the same category of women). Regional anaesthesia complications displayed a complex relationship with maternal BMI, with women in intermediate obesity categories having decreased odds as compared to normal-weight women, and women in the highest BMI category having a twofold increased risk of complications (RR 2.34, 95% CI 1.37, 4.02 for primiparous women). Conclusion: Labouring women in higher BMI categories were more likely to receive regional anaesthesia and more likely to deliver via caesarean compared to normal weight women and women without regional anaesthesia. Rates of anaesthesia complications were highest among women in the highest BMI category.

KW - BMI

KW - caesarean delivery

KW - labour

KW - regional anaesthesia

UR - http://www.scopus.com/inward/record.url?scp=85034207168&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85034207168&partnerID=8YFLogxK

U2 - 10.1111/ppe.12387

DO - 10.1111/ppe.12387

M3 - Article

VL - 31

SP - 495

EP - 505

JO - Paediatric and Perinatal Epidemiology

JF - Paediatric and Perinatal Epidemiology

SN - 0269-5022

IS - 6

ER -