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Maternal Prepregnancy Overweight and Obesity and the Pattern of Labor Progression in Term Nulliparous Women

Anjel Vahratian, PhD, MPH^*, Jun Zhang, PhD, MD, James F. Troendle, PhD, David A. Savitz, PhD^¶ and Anna Maria Siega-Riz, PhD^*¶

From the Departments of *Maternal and Child Health and Epidemiology, School of Public Health; the Department of Nutrition, School of Medicine and School of Public Health; and the ¶Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and the Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland.

OBJECTIVE: To examine the effect of maternal overweight and obesity on labor progression.

METHODS: We analyzed data from 612 nulliparous women with a term pregnancy that participated in the Pregnancy, Infection, and Nutrition Study from 1995 to 2002. The median duration of labor by each centimeter of cervical dilation was computed for normal-weight (body mass index [BMI] 19.8–26.0 kg/m²), overweight (BMI 26.1–29.0 kg/m²), and obese (BMI > 29.0 kg/m²) women and used as a measurement of labor progression.

RESULTS: After adjusting for maternal height, labor induction, membrane rupture, oxytocin use, epidural analgesia, net maternal weight gain, and fetal size, the median duration of labor from 4 to 10 cm was significantly longer for both overweight and obese women, compared with normal-weight women (7.5, 7.9, and 6.2 hours, respectively). For overweight women, the prolongation was concentrated around 4–6 cm, whereas for obese women, their labor was significantly slower before 7 cm.

CONCLUSION: Labor progression in overweight and obese women was significantly slower than that of normal-weight women before 6 cm of cervical dilation. Given that nearly one half of women of childbearing age are either overweight or obese, it is critical to consider differences in labor progression by maternal prepregnancy BMI before additional interventions are performed.

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