Gibbs Pickens CM, et al. - Researchers here evaluated if elective induction of labor between 39 through 41 weeks of gestation, as compared with expectant management, was associated with reduced cesarean delivery and other adverse outcomes among obese women and their offspring. Based on the findings, they concluded that elective labor induction between 39 0/7 and 40 6/7 weeks of gestation had association with reduced maternal and neonatal morbidity among obese women.

Methods

• A retrospective cohort study was performed using the 2007–2011 California Linked Patient Discharge Data–Birth Cohort File of 165,975 singleton, cephalic, nonanomalous deliveries to obese women.
• Researchers used multivariable logistic regression models, stratified by parity for each gestational week (39–41) to ascertain if elective induction of labor or expectant management was associated with lower odds of cesarean delivery and other adverse outcomes.

Results

• In obese nulliparous women who were electively induced, cesarean delivery was less common at 39 and 40 weeks of gestation compared with those who were expectantly managed (at 39 weeks of gestation, frequencies were 35.9% vs 41.0%, respectively [P < .05]; adjusted odds ratio [OR] 0.82, 95% CI 0.77–0.88).
• Among electively induced obese nulliparous patients, severe maternal morbidity was less common (at 39 weeks of gestation, 5.6% vs 7.6% [P<.05]; adjusted OR 0.75, 95% CI 0.65–0.87).
• In these women, less common neonatal intensive care unit admission was also observed (at 39 weeks of gestation, 7.9% vs 10.1% [P < .05]; adjusted OR 0.79, 95% CI 0.70–0.89).
• Among obese parous women, patterns were similar at 39 weeks of gestation (crude frequencies and adjusted ORs [95% CIs] were as follows: for cesarean delivery, 7.0% vs 8.7% [P<.05] and 0.79 [0.73–0.86]; for severe maternal morbidity, 3.3% vs 4.0% [P < .05] and 0.83 [0.74–0.94]; for neonatal intensive care unit admission: 5.3% vs 7.4% [P < .05] and 0.75 [0.68–0.82]).
• Similarly, an association of elective induction at 40 weeks was observed with reduced odds of cesarean delivery, maternal morbidity, and neonatal intensive care unit admission among both obese nulliparous and parous patients.