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Publication . Doctoral thesis . 2015

Maternal Obesity and Fetal Macrosomia : Complications and Obstetric Management

Fuchs, Florent;
French
Published: 27 Oct 2015
Publisher: HAL CCSD
Country: France
Abstract

Background: According to WHO, obesity is considered as an "epidemic" condition due to the global growth of its prevalence and its impact on patient health. For pregnant patients, its impact seems equally worrying and its prevalence is now reaching 10% in France. Some complications of obesity in pregnant women have been little studied and particularly the special link with fetal macrosomia.Objectives: To better understand care and obstetric outcome of obese pregnant patients as well as some of their complications such as fetal macrosomia.Methods: Three different sets of data were used to deal with questions regarding obesity and macrosomia. 1) Assessment of feasibility and quality of second trimester ultrasound scan in obese patients was performed through a mono centric case-control study with prospective data collection. 2) A study of risk factors for maternal complications in case of the delivery of a macrosomic child, regardless of maternal obesity and child's birth weight, was conducted as a prospective cohort study including children with birthweight above 4000g in two “Ile de France” maternity wards. 3) Finally, a comparison of the relationship between maternal and/or neonatal complications of pregnancy and obesity was conducted in France (4 type III maternity wards) and in Quebec (data from a randomized study throughout the province) between 2009 and 2011 through a comparative study of two cross-sectional samples of pregnant women (26,973 births in France and 83,545 births in Quebec).Results: 1) Second trimester ultrasound scan in obese pregnant women is feasible, with a success rate of 70.4% (versus 82%; p=0.08). Factors of improvement were: to spend more time at ultrasound (p=0.03), to move the fetus so that its back is in lateral or posterior position (p=0.01) and when ultrasound was performed by experienced sonographers (p=0.03). However, the quality of the image remains significantly lower in the obese population (p=0.001). 2) The occurrence of maternal complications, when attempting vaginal birth of a child of more than 4000g, was 6%. Beyond childbirth weight (p=0.004, attributable risk (AR) = 10%), the risk factors of maternal complications were Asian ethnicity (p=0.04; AR=3%), prolonged labor (> 10h) (p=0.02; AR=12%), and caesarean section during labor (p=0.004; AR=17%). Multiparous women with a previous vaginal delivery of a macrosomic child had a lower risk of maternal complications (p=0.03). 3) The prevalence of obesity was 9.1% in France and 16.8% in Quebec (p 10h) (p=0,02 ; RA=12%), et une césarienne au cours du travail (p=0,004 ; RA=17%). Les patientes multipares ayant déjà accouché par voie vaginale d'un enfant macrosome avaient un risque diminué de complications maternelles (p=0,03). 3) La prévalence de l'obésité était de 9,1% en France et 16,8% au Québec (p<0,001). L'obésité était associée de manière statistiquement significative (p<0,0001), à la fois en France et au Québec, à un risque accru de diabète gestationnel, de troubles hypertensifs de la grossesse, de prééclampsie, de mort fœtale in utero, d'accouchement par césarienne et de macrosomie. L'association était différente en France et au Québec (p interaction <0,005), pour la survenue du diabète gestationnel, de complications hypertensives de la grossesse et pour la macrosomie, avec une augmentation plus importante des complications avec l'IMC au Québec par rapport à la France.Conclusion : La compréhension de certaines complications inhérentes à l'obésité (complications médicales de la grossesse, faisabilité et qualité du dépistage échographique, complications obstétricales) est améliorée par les résultats de cette thèse.

Subjects

Obesity, Complications, Macrosomia, Ultrasound, Obésité, Macrosomie, Echographie, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics

Related Organizations

Annexe 4: Fuchs F, Bouyer J, Rozenberg P, Senat MV. Adverse maternal outcomes associated with fetal macrosomia: what are the risk factors beyond birthweight? BMC Pregnancy Childbirth. 2013; 8 ; 13:90........................................................................................................................................... 119 Annexe 5 : Fuchs F, Voulgaropoulos A, Houllier M, Senat MV. Could we perform quality second trimester ultrasound among obese pregnant women? J Gynecol Obstet Biol Reprod. 2013; 42 (3): 275-81.............................................................................................................................................. 126 Annexe 6 : Grevoul-Fesquet J, Fuchs F, Debras E, Neveu ME, Senat MV. Obésité et Grossesse: suivi et accouchement. Médecine Clinique endocrinologie et diabète 2012:59; 30-7. ................... 134 Annexe 7 : Fuchs F. Échographie obstétricale chez les patientes obèses : Trucs et astuces pour s'en sortir. Gynécologie et Obstétrique Pratique. 2012. N°242. Page 6-7.............................................. 143

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