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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 46, Issue 8


Effect of pre-pregnancy body mass index on respiratory-related neonatal outcomes in women undergoing elective cesarean prior to 39 weeks

Sophie Vincent
  • Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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/ Nicholas Czuzoj-Shulman
  • Center for Clinical Epidemiology and Community Studies, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
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/ Andrea R. Spence
  • Center for Clinical Epidemiology and Community Studies, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
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/ Haim A. Abenhaim
  • Corresponding author
  • Center for Clinical Epidemiology and Community Studies, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
  • Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Pav H, Room 325, 5790 Cote-Des-Neiges Road, Montreal, QC, H3S 1Y9, Canada, Tel.: 514-340-8271, Fax: 514-340-7941
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Published Online: 2018-03-15 | DOI: https://doi.org/10.1515/jpm-2017-0384



To examine the association between pre-pregnancy body mass index (BMI) and neonatal respiratory-related outcomes among women who underwent an elective cesarean section (CS).


A retrospective cohort study was conducted using the Centers for Disease Control and Prevention (CDC)’s 2009–2013 period linked birth/infant death dataset. Women who had elective CSs at term were categorized by their pre-pregnancy BMI as normal, overweight, obese or morbidly obese. Odds ratios (OR) and 95% confidence intervals (CIs), adjusted for baseline characteristics, were calculated using multivariate logistic regression to estimate the neonatal risks in relation to maternal pre-pregnancy BMI.


Our cohort consisted of 717,080 women, of whom 39.9% had normal BMI, 27.0% were overweight, 25.7% obese and 7.4% morbidly obese. A dose-dependent relationship between maternal pre-pregnancy BMI and assisted ventilation was seen. Furthermore, infants born to morbidly obese women were at significantly increased risk for assisted ventilation over 6 h (OR 1.24, 95% CI 1.15–1.35) and admission to intensive care units (OR 1.17, 95% CI 1.13–1.21). Infant mortality rates were 4.2/1000 births for normal weight women, and 5.5/1000 births among the morbidly obese group (OR 1.43, 95% CI 1.25–1.64). Risk for adverse outcomes was increased with elective SC performed at earlier gestational age, and this effect was not modified by use of corticosteroids.


Overweight and obese women are at particularly greater risk of adverse newborn outcomes when elective CSs are done before 39 weeks. In these women, elective CSs should be delayed until 39 weeks, as corticosteroid use did not eliminate this association.

Keywords: Body mass index; elective cesarean section; neonatal outcomes; obesity


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About the article

Received: 2017-12-05

Accepted: 2018-02-19

Published Online: 2018-03-15

Published in Print: 2018-10-25

Author’s statement

Conflict of interest: Authors state no conflict of interest.

Material and methods: Informed consent was not obtained by us as we used data from an existing publicly available dataset.

Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

Citation Information: Journal of Perinatal Medicine, Volume 46, Issue 8, Pages 905–912, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2017-0384.

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