Pregnancy Outcome in Women with Pre-pregnancy Class 3 Obesity: A Multicenter Retrospective Cohort Study

Authors

  • Rawisara Champawong Na Klang Hospital, Nong Bua Lam Phu Province, Thailand
  • Metha Songthamwat Department of Obstetrics and Gynecology, Udon Thani Hospital, UdonThani Province, Thailand
  • Srisuda Songthamwat Phetchabun Hospital, Phetchabun Province, Thailand
  • Yaowaret Kittithanesuan Ang Thong Hospital, Ang Thong Province, Thailand
  • Siriluk Norsuwan Kumphawapi Hospital, Udon Thani Province, Thailand
  • Nopporn Limwatanapan Wanonniwat Hospital, Sakon Nakhon Province, Thailand
  • Sunanthaporn Phaiphan Lomsak Hospital, Phetchabun Province, Thailand
  • Pimjai Maleerat Ban Phue Hospital, UdonThani Province, Thailand
  • Koollachart Saejueng Ban Dung Hospital, UdonThani Province, Thailand
  • Anuchat Sujita Nong Han Hospital, Udon Thani Province, Thailand
  • Ueamporn Summart Faculty of Nursing, Roi Et Rajabhat University, Roi Et Province, Thailand

Keywords:

morbid obesity, class 3 obesity, fetal macrosomia, gestational diabetes, preeclampsia

Abstract

Background and Objective: Maternal class 3 obesity (Body mass index, BMI ≥ 40 kg/m2) is associated with many pregnancy complications. However, the current data of this condition in Thailand is still limited. This study aimed to study the prevalence of class 3 obesity in pregnant women, maternal complications and neonatal outcomes in Thailand.

Methods: A multicenter nested case-control  study was conducted. The inclusion criteria were singleton pregnant women who delivered in Na Klang, Kumphawapi, Udonthani, Nonghan, Ban phue, Wanonniwat, Ban dung, Lomsak, and Ang thong Hospital during January, 2018 to December, 2023 and had their first antenatal care at ≤ 20 weeks gestation. The exclusion criteria were the incompleteness of significant information, such as pre-pregnancy weight or pregnancy complication. Data were collected from the electronic database then analyzed using descriptive statistics and multiple logistic regression. The pre-pregnancy class 3 obesity group was compared with a computer-randomly selected control group with normal BMI.

Results: The medical records of 44,885 cases were included. The class 3 obesity was found in 289 cases (0.64%). The 867 controls (normal BMI) were randomly selected. A significantly higher rate of gestational diabetes mellitus (AOR 7.46, 95% CI 3.16-17.66), preeclampsia (AOR 8.20, 95% CI 4.08-16.49), fetal macrosomia (AOR 10.26, 95% CI 1.94-54.29) and large for gestational age (AOR 3.41, 95% CI 1.81-6.41) was noted in the class 3 obesity group compared to the normal BMI group.

Conclusion: The prevalence of class 3 obesity pregnancy was 0.64 %. This condition significantly increased the risk of both maternal and neonatal complications, such as gestational diabetes mellitus, preeclampsia, fetal macrosomia and large for gestational age. Therefore, pre-pregnancy weight control and proper prenatal care are important in this group to decrease risk of pregnancy complications.

References

World Health Organization. Obesity and overweight 2024. [cited Feb 4, 2025]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.

Perreault L. Obesity in adults: Prevalence, screening, and evaluation. In: UpToDate, Pi-Sunyer X, (Ed), Wolters Kluwer. [cited May 14, 2025]. Available from: https://www.uptodate.com/contents/obesity-in-adults-prevalence-screening-and-evaluation

Aekplakorn W. The 6th Thailand national health examination surveys report 2019-2020. Bangkok: Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 2021.

Center for Disease Control. Adult BMI Categories 2024. [cited Feb 4, 2025]. Available from: https://www.cdc.gov/bmi/adult-calculator/bmi-categories.html.

Jitnarin N, Kosulwat V, Rojroongwasinkul N, Boonpraderm A, Haddock CK, Poston WS. Prevalence of overweight and obesity in Thai population: results of the National Thai Food Consumption Survey. Eat Weight Disord 2011;16(4):e242-9. doi:10.1007/BF03327467

Dodd JM, Grivell RM, Nguyen AM, Chan A, Robinson JS. Maternal and perinatal health outcomes by body mass index category. Aust N Z J Obstet Gynaecol 2011;51(2):136-40. doi:10.1111/j.1479-828X.2010.01272.x

Kerrigan AM, Kingdon C. Maternal obesity and pregnancy: a retrospective study. Midwifery 2010;26(1):138-46. doi:10.1016/j.midw.2008.12.005

Sukalich S, Mingione MJ, Glantz JC. Obstetric outcomes in overweight and obese adolescents. Am J Obstet Gynecol 2006;195(3):851-5. doi:10.1016/j.ajog.2006.06.070

Scott‐Pillai Ra, Spence D, Cardwell C, Hunter A, Holmes V. The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004-2011. BJOG 2013;120(8):932-9. doi:10.1111/1471-0528.12193

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(4):1091-7. doi:10.1016/j.ajog.2003.09.058

Lisonkova S, Muraca GM, Potts J, Liauw J, Chan WS, Skoll A, et al. Association between prepregnancy body mass index and severe maternal morbidity. JAMA 2017;318(18):1777-86. doi:10.1001/jama.2017.16191

Briese V, Voigt M, Hermanussen M, Wittwer-Backofen U. Morbid obesity: pregnancy risks, birth risks and status of the newborn. Homo 2010;61(1):64-72. doi:10.1016/j.jchb.2009.11.002

Cedergren MI. Maternal morbid obesity and the risk of adverse pregnancy outcome. Obstet Gynecol 2004;103(2):219-24. doi:10.1097/01.AOG.0000107291.46159.00

Crane JM, Murphy P, Burrage L, Hutchens D. Maternal and perinatal outcomes of extreme obesity in pregnancy. J Obstet Gynaecol Can 2013;35(7):606-11. doi:10.1016/S1701-2163(15)30879-3

Kumari A. Pregnancy outcome in women with morbid obesity. Int J Gynaecol Obstet 2001;73(2):101-7. doi:10.1016/S0020-7292(00)00391-X

Centers for Disease Control and Prevention. Morbid Obesity 2007. [cited November 27, 2024]. Available from: https://blogs.cdc.gov/nchs/2007/06/13/7091/

Lim JU, Lee JH, Kim JS, Hwang YI, Kim TH, Lim SY, et al. Comparison of World Health Organization and Asia-Pacific body mass index classifications in COPD patients. Int J Chron Obstruct Pulmon Dis 2017;12:2465-75. doi:10.2147/COPD.S141295

Boyle A, Reddy UM, Landy HJ, Huang CC, Driggers RW, Laughon SK. Primary cesarean delivery in the United States. Obstet Gynecol 2013;122:33-40. doi:10.1097/AOG.0b013e3182952242

Borisut P, Kovavisarach E. Standard intrauterine growth curve of Thai neonates delivered at Rajavithi hospital. J Med Assoc Thai 2014;97(8):798-803.

Rasmussen KM, Catalano PM, Yaktine AL. New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know. Curr Opin Obstet Gynecol 2009;21(6):521-6. doi:10.1097/GCO.0b013e328332d24e

Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 2018;138:271-81. doi:10.1016/j.diabres.2018.02.023

Phadungkiatwattana P, Tongsakul N. Analyzing the impact of private service on the cesarean section rate in public hospital Thailand. Arch Gynecol Obstet 2011;284:1375-9. doi:10.1007/s00404-011-1867-0

Downloads

Published

2025-06-23

How to Cite

1.
Champawong R, Songthamwat M, Songthamwat S, Kittithanesuan Y, Norsuwan S, Limwatanapan N, Phaiphan S, Maleerat P, Saejueng K, Sujita A, Summart U. Pregnancy Outcome in Women with Pre-pregnancy Class 3 Obesity: A Multicenter Retrospective Cohort Study . SRIMEDJ [internet]. 2025 Jun. 23 [cited 2026 Jan. 30];40(3):290-8. available from: https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/266566

Issue

Vol. 40 No. 3 (2025): May - June

Section

Original Articles

License

Copyright (c) 2025 Srinagarind Medical Journal

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.