Maternal Body Mass Index and Use of Labor Neuraxial Analgesia: A Population-based Retrospective Cohort Study

Alexander J Butwick; Cynthia A Wong; Nan Guo

doi:10.1097/ALN.0000000000002322

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Maternal Body Mass Index and Use of Labor Neuraxial Analgesia: A Population-based Retrospective Cohort Study

Journal article

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Peer reviewed

Maternal Body Mass Index and Use of Labor Neuraxial Analgesia: A Population-based Retrospective Cohort Study

Alexander J Butwick, Cynthia A Wong and Nan Guo

Anesthesiology (Philadelphia), Vol.129(3), pp.448-458

09/2018

DOI: 10.1097/ALN.0000000000002322

PMCID: PMC6118130

PMID: 29939847

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Abstract

WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Neuraxial labor analgesia may benefit obese women by optimizing cardiorespiratory function and mitigating complications related to emergency general anesthesia. We hypothesized that obese women have a higher rate of neuraxial analgesia compared with nonobese parturients. Using U.S. natality data, our cohort comprised 17,220,680 deliveries, which accounts for 61.5% of 28 million births in the United States between 2009 and 2015. We examined the relationships between body mass index class and neuraxial labor analgesia, adjusting for sociodemographic, antenatal, pregnancy, and peripartum factors. The study cohort comprised 17,220,680 women; 0.1% were underweight, 12.7% were normal body mass index, 37% were overweight, and 28.3%, 13.5%, and 8.4% were obesity class I, II, and III, respectively. Rates of neuraxial analgesia by body mass index class were as follows: underweight, 59.7% (9,030/15,128); normal body mass index, 68.1% (1,487,117/2,182,797); overweight, 70.3% (4,476,685/6,368,656); obesity class I, 71.8% (3,503,321/4,881,938); obesity class II, 73.4% (1,710,099/2,330,028); and obesity class III, 75.6% (1,089,668/1,442,133). Compared to women with normal body mass index, the likelihood of receiving neuraxial analgesia was slightly increased for overweight women (adjusted relative risk, 1.02; 95% CI, 1.02 to 1.02), obese class I (adjusted relative risk, 1.04; 95% CI, 1.04 to 1.04), obese class II (adjusted relative risk, 1.05; 95% CI, 1.05 to 1.05), and obese class III (adjusted relative risk, 1.06; 95% CI, 1.06 to 1.06). Our findings suggest that the likelihood of receiving neuraxial analgesia is only marginally increased for morbidly obese women compared to women with normal body mass index.

Body Mass Index

Humans

Middle Aged

Anesthesia, Conduction - methods

Maternal Health - trends

Pregnancy

Young Adult

Delivery, Obstetric - methods

Analgesia, Obstetrical - methods

Obesity - epidemiology

Adolescent

Anesthesia, Conduction - trends

Delivery, Obstetric - trends

Adult

Analgesia, Obstetrical - trends

Female

Obesity - diagnosis

Retrospective Studies

Population Surveillance - methods

Cohort Studies

Details

Title: Subtitle: Maternal Body Mass Index and Use of Labor Neuraxial Analgesia: A Population-based Retrospective Cohort Study
Creators: Alexander J Butwick - From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California (A.J.B., N.G.) the University of Iowa Carver College of Medicine, Iowa City, Iowa (C.A.W.)
Cynthia A Wong
Nan Guo
Resource Type: Journal article
Publication Details: Anesthesiology (Philadelphia), Vol.129(3), pp.448-458
DOI: 10.1097/ALN.0000000000002322
PMID: 29939847
PMCID: PMC6118130
NLM abbreviation: Anesthesiology
ISSN: 0003-3022
eISSN: 1528-1175
Publisher: United States
Grant note: K23 HD070972 / NICHD NIH HHS
Language: English
Date published: 09/2018
Academic Unit: Anesthesia
Record Identifier: 9984006482702771

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