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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica

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Volume 43, Issue 4


Impact of maternal body mass index on the cesarean delivery rate in Germany from 1990 to 2012

Ioannis Kyvernitakis
  • Corresponding author
  • Department of Obstetrics and Gynecology, University Hospital of Giessen and Marburg, Campus Marburg, Philipps University of Marburg, Balingerstr. 1, 35043 Marburg, Germany
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/ Christine Köhler / Stephan Schmidt / Björn Misselwitz / Jasmin Großmann / Peyman Hadji / Matthias Kalder
Published Online: 2014-06-10 | DOI: https://doi.org/10.1515/jpm-2014-0126


Aims: Maternal obesity is a risk factor for cesarean delivery (CD). The aim of this analysis was to determine the association between early-pregnancy body mass index (BMI) and the rate of CD over the past two decades.

Methods: We retrospectively analyzed data from the perinatal quality registry of singleton deliveries in the state of Hesse in Germany from 1990 to 2012. We divided the patients into groups according to the WHO criteria for BMI: underweight (<18.5), normal weight (18.5–<25), overweight (25–<30), obese class I (30–<35), obese class II (35–<40), and obese class III (≥40).

Results: The analysis included 1,092,311 patients with available data regarding maternal BMI and mode of delivery. The CD rates for underweight (<18.5), normal weight (18.5–<25), overweight (25–<30), obese class I (30–<35), obese class II (35–<40), and obese class III (≥40) women increased from 14.4%, 16.1%, 19.5%, 22.3%, 25%, and 26.9% in the year 1990 to 27.9%, 31.4%, 38.8%, 45.1%, 50.2%, and 55.2% in the year 2012, respectively (P<0.001).

Conclusion: Maternal BMI in early pregnancy is linearly associated with the incidence of CD. We found a disproportionate increase of CD in morbidly obese women compared with the CD incidence in the reference BMI population over the past two decades.

Keywords: Body mass index (BMI); cesarean delivery (CD); maternal obesity


  • [1]

    Barau G, Robillard PY, Hulsey TC, Dedecker F, Laffite A, Gérardin P, et al. Linear association between maternal pre-pregnancy body mass index and risk of caesarean section in term deliveries. Br J Obstet Gynaecol. 2006;113:1173–7.Google Scholar

  • [2]

    Blomberg M. Maternal obesity, mode of delivery, and neonatal outcome. Obstet Gynecol. 2013;122:50–5.Google Scholar

  • [3]

    Clark SL, Belfort MA, Dildy GA, Herbst MA, Meyers JA, Hankins GD. Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery. Am J Obstet Gynecol. 2008;199:36.e1–5; discussion 91.Web of ScienceGoogle Scholar

  • [4]

    Crane SS, Wojtowycz MA, Dye TD, Aubry RH, Artal R. Association between pre-pregnancy obesity and the risk of cesarean delivery. Obstet Gynecol. 1997;89:213–16.Google Scholar

  • [5]

    Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. J Am Med Assoc. 2010;303:235–41.Google Scholar

  • [6]

    Graham LE, Brunner Huber LR, Thompson ME, Ersek JL. Does amount of weight gain during pregnancy modify the association between obesity and cesarean section delivery? Birth. 2014;41:93–9.Google Scholar

  • [7]

    Haeri S, Guichard I, Baker AM, Saddlemire S, Boggess KA. The effect of teenage maternal obesity on perinatal outcomes. Obstet Gynecol. 2009;113:300–4.Google Scholar

  • [8]

    Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2012. Natl Vital Stat Rep. 2013;62:1–20.Google Scholar

  • [9]

    Kalache KD, Duckelmann AM, Michaelis SA, Lange J, Cichon G, Dudenhausen JW. Transperineal ultrasound imaging in prolonged second stage of labor with occipitoanterior presenting fetuses: how well does the ‘angle of progression’ predict the mode of delivery? Ultrasound Obstet Gynecol. 2009;33:326–30.Web of ScienceGoogle Scholar

  • [10]

    Kyvernitakis A, Kyvernitakis I, Karageorgiadis AS, Misselwitz B, Papaspyrou G, Kalder M, et al. Rising cesarean rates of twin deliveries in Germany from 1990 to 2012. Z Geburtshilfe Neonatol. 2013;217:177–82.Web of ScienceGoogle Scholar

  • [11]

    Lynch CM, Sexton DJ, Hession M, Morrison JJ. Obesity and mode of delivery in primigravid and multigravid women. Am J Perinatol. 2008;25:163–7.Web of ScienceGoogle Scholar

  • [12]

    Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: a systematic review. Am J Obstet Gynecol. 2011;205:262.e1–8.Web of ScienceGoogle Scholar

  • [13]

    Placek PJ, Taffel SM. Trends in cesarean section rates for the United States, 1970–1978. Public Health Rep. 1980;95:540–8.Google Scholar

  • [14]

    Poobalan AS, Aucott LS, Gurung T, Smith WC, Bhattacharya S. Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women–systematic review and meta-analysis of cohort studies. Obes Rev. 2009;10:28–35.Web of ScienceGoogle Scholar

  • [15]

    Robinson BK, Mapp DC, Bloom SL, Rouse DJ, Spong CY, Varner MW, et al. Increasing maternal body mass index and characteristics of the second stage of labor. Obstet Gynecol. 2011;118:1309–13.Google Scholar

  • [16]

    Roman H, Goffinet F, Hulsey TF, Newman R, Robillard PY, Hulsey TC. Maternal body mass index at delivery and risk of caesarean due to dystocia in low risk pregnancies. Acta Obstet Gynecol Scand. 2008;87:163–70.Web of ScienceGoogle Scholar

  • [17]

    Sebire NJ, Jolly M, Harris J, Regan L, Robinson S. Is maternal underweight really a risk factor for adverse pregnancy outcome? A population-based study in London. Br J Obstet Gynaecol. 2001;108:61–6.Google Scholar

  • [18]

    Weiss JL, Malone FD, Emig D, Ball RH, Nyberg DA, Comstock CH, et al. Obesity, obstetric complications and cesarean delivery rate–a population-based screening study. Am J Obstet Gynecol. 2004;190:1091–7.Google Scholar

About the article

Corresponding author: Dr. Ioannis Kyvernitakis, MD, Department of Obstetrics and Gynecology, University Hospital of Giessen and Marburg, Campus Marburg, Philipps University of Marburg, Balingerstr. 1, 35043 Marburg, Germany, Tel.: +49 6421 5861 865; Mobile: +49 151 2296 4501, E-mail:

Received: 2014-04-14

Accepted: 2014-05-19

Published Online: 2014-06-10

Published in Print: 2015-07-01

Citation Information: Journal of Perinatal Medicine, Volume 43, Issue 4, Pages 449–454, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2014-0126.

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